Oral Appliances in Obstructive Sleep Apnea

Abstract

Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

Telemedicine in Sleep-Disordered Breathing

“…When combining with triple axis accelerometer technologies, oral appliance use times as well as supine versus nonsupine data can be monitored, and eventually shared web based between patient and care giver. 161 Similar developments take place for hypoglossal nerve stimulation devices. 162…”

“…Emerging technologies are available that have sleep (position) e-monitoring capabilities. 161 For instance, telemonitoring of oral appliance compliance data is feasible, based on temperature-sensing data chips embedded in the oral appliance. When combining with triple axis accelerometer technologies, oral appliance use times as well as supine versus nonsupine data can be monitored, and eventually shared web based between patient and care giver.…”

Sleep Bruxism Episodes in Patients with Obstructive Sleep Apnea Syndrome Determined by In-Laboratory Polysomnography

“…Although continuous positive airway pressure (CPAP) therapy is highly effective for treating patients with OSAS, there are several confounding issues of CPAP therapy, such as problems with adaptation to devices and compliance [4]. An oral appliance is one superior alternative approach to CPAP for patients suffering from OSAS [5,6]. SB in a patient with OSAS might affect the treatment using an oral appliance instead of CPAP therapy.…”

Obstrüktif uyku apne sendromu olan hastalarda CPAP tedavisinin klinik periodontal duruma etkisi: Altı yıllık takip

“…2 Obstrüktif uyku apne sendromu (OUAS), uyku sırasında üst hava yolunun (UA) tekrarlayan daralması (hipopne) veya kapanmasıdır (apne), aralıklı hipoksiye, intratorasik basınç dalgalanmaları, sempatik değişiklikler ve uyku bölünmesine neden olur. 3,4 Bu değişiklikler nedeniyle OUAS hastalarında aşırı gündüz uykululuk, yorgunluk, bilişsel performans bozukluğu, düşük yaşam kalitesi, artan iş ve trafik kazası riski, OUAS ile ilişkili morbiditeler ve mortalite sıktır. 4 Uyku apnesi en çok orta yaşta, obez kişilerde ve erkeklerde görülür.…”

“…3,4 Bu değişiklikler nedeniyle OUAS hastalarında aşırı gündüz uykululuk, yorgunluk, bilişsel performans bozukluğu, düşük yaşam kalitesi, artan iş ve trafik kazası riski, OUAS ile ilişkili morbiditeler ve mortalite sıktır. 4 Uyku apnesi en çok orta yaşta, obez kişilerde ve erkeklerde görülür. 5 Hipertansiyon, konjestif kalp yetmezliği, miyokard infarktüsü, kardiyak aritmiler, inme, diyabet, insülin direnci, dislipidemi gibi kardiyovasküler, serebrovasküler ve metabolik hastalıklar, OUAS hastalarında oldukça sık saptanmaktadır.…”