Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea: A Review

Schmidt-Nowara, Wolfgang; Lowe, Alan A.; Wiegand, Laurel; Cartwright, Rosalind D.; Perez-Guerra, Francisco; Menn, Stuart J.

doi:10.1093/sleep/18.6.501

Cited by 446 publications

(321 citation statements)

References 52 publications

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“…Other published studies documenting side-effects experienced during MRS treatment also report a number of patients suffering one or more side-effects; in this study 5% of subjects reported all side-effect categories. 10,12,13,17 Excess salivation was the most frequently reported side-effect, in agreement with the findings of a recent randomised clinical trial published by Johnston et al 13 This is to be expected in the first week of appliance wear, but diminishes after a few days of wear. 10,12,18 Soreness was also frequently reported but may be dealt with by simple adjustment of the appliance.…”

Section: Side-effects (Fig 2)supporting

confidence: 87%

“…Wherever possible questions were used that had appeared in previous published studies to enable comparison. [10][11][12][13] An initial pilot study was carried out on 10 subjects who were not included in the study, to test the questionnaire's suitability. Minor alterations in terms of grammar were made to three of the questions to improve clarity.…”

Section: Questionnaire Surveymentioning

confidence: 99%

“…3 The increased mean BMI was also expected as obese patients have been shown to have a higher incidence of OSAHS. 10 Mean pre-treatment ESS any treatment as prescribed, and that compliance is not associated with age, sex, education, economic status, or disease characteristics. 15 Data on long term MRS compliance are limited, with a range of 52-100% reported.…”

Section: Subjects (Table 1)mentioning

confidence: 99%

“…15 Data on long term MRS compliance are limited, with a range of 52-100% reported. 10,13,14,16 Schmidt-Nowara in 1995 reported that patients must receive initial written instruction to produce the best rates of compliance; hence in this study patients were given written instructions at their initial visit and on fitting the MRS. 10 The compliance rate of 68% achieved is comparable with results of other studies such as 75% achieved by Schmidt-Nowara in 1995, 10 and 76% achieved by Johal in 1999. 11…”

Section: Subjects (Table 1)mentioning

confidence: 99%

“…13 Discomfort of the temporomandibular joint was reported by 54% of patients which is comparable to other figures found in contemporary literature. 10,12,13 This may be minimised by careful assessment of the degree of mandibular protrusion. 12 It may be wiser in practice to advance the mandible to the maximum comfortable position rather than by a standard amount such as 75% of the maximum as is often described.…”

Section: Side-effects (Fig 2)mentioning

confidence: 99%

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Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint

Bates¹,

McDonald

2006

Br Dent J

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Aim To determine in detail the complications associated with the use of mandibular repositioning splints (MRS) to treat sleep-related breathing disorders. Method This prospective cross-sectional cohort study audits the management with mandibular repositioning splints of 121 patients suffering from sleep-related breathing disorders. Investigation of patients' and sleeping partners' perspectives on treatment was undertaken with the use of a questionnaire based study. Results Sixty-eight per cent of respondents reported that they were compliant with treatment; various side effects were reported of which excess salivation was the most common. Investigation of sleeping partners' perspectives revealed that 70% felt that their partners' snoring was improved and 47% felt that their partner's breathing pauses during sleep were reduced. Sixty-four per cent of the sleeping partners also reported that their own sleep pattern had improved since their partner's treatment. Conclusion Mandibular repositioning splints used in the manner described by this paper are demonstrated to have a good compliance rate, provide successful treatment and exhibit only minor, reversible side effects.

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Section: Side-effects (Fig 2)supporting

confidence: 87%

Section: Questionnaire Surveymentioning

confidence: 99%

Section: Subjects (Table 1)mentioning

confidence: 99%

Section: Subjects (Table 1)mentioning

confidence: 99%

Section: Side-effects (Fig 2)mentioning

confidence: 99%

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Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint

Bates¹,

McDonald

2006

Br Dent J

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Therapeutic Electrical Stimulation of the Hypoglossal Nerve in Obstructive Sleep Apnea

Schwartz¹,

Bennett²,

Smith³

et al. 2001

Arch Otolaryngol Head Neck Surg

268

184

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A 54-Year-Old Man With Obstructive Sleep Apnea

Kuna¹

2002

JAMA

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Mr J is a 54-year-old man with a history of sleep apnea. He lives in a suburb of Boston with his wife and 2 children, owns a small company, and has managed care insurance.In 1995, Mr J's wife noted that he stopped breathing at night. Mr J also recalled that he awoke, on occasion, in the middle of the night with palpitations. He mentioned this to his primary care physician, Dr M, who referred him for a sleep study. The study revealed 206 obstructive events, giving an apnea hypopnea index (AHI) of 36 per hour. He had oxygen desaturation to a nadir of 74%. Based on these results, his pulmonologist recommended that Mr J proceed with nasal continuous positive airway pressure (CPAP) titration. The results of his CPAP study showed that 5 to 6 cm of water pressure eliminated the obstructive events and oxygen desaturation. Mr J seemed to have some difficulty falling asleep with the mask, but overall it appeared to be well tolerated during both rapid eye movement (REM) and non-REM sleep.With the nasal CPAP, Mr J's palpitations ceased, but after about a year he discontinued the nasal CPAP because it interfered with his ability to fall asleep and with his sex life. A trial of clonazepam, 0.25 mg, about a half hour before sleep did not improve his ability to sleep with the CPAP. When he pursued the use of an oral device, Mr J was told that the most effective agent for treatment of sleep apnea was nasal CPAP, but he did not resume its use.Currently, Mr J states that he feels well. He falls asleep without difficulty and is able to sleep about 8 hours per night. He does not experience shortness of breath and he does not perceive any difficulties with his sleep patterns or daytime sleepiness.Mr J has a medical history of coronary artery disease (with stent placement), hypertension, hyperlipidemia, diverticulitis, recurrent sinusitis, and L5-S1 radiculopathy. Because of his history of coronary artery disease and hypertension, Dr M strongly encouraged Mr J to use his nasal CPAP. Mr J stated that he could not tolerate CPAP, but he did lose 20 lb and now weighs 205 lb (his body mass index [BMI] is now 28.6). Mr J's current medications include aspirin, atenolol, atorvastatin, gabapentin, and ibuprofen. He does not smoke and rarely drinks.

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Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea: A Review

Cited by 446 publications

References 52 publications

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint

Therapeutic Electrical Stimulation of the Hypoglossal Nerve in Obstructive Sleep Apnea

A 54-Year-Old Man With Obstructive Sleep Apnea

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