Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005

Abstract

These practice parameters are an update of the previously published recommendations regarding use of oral appliances in the treatment of snoring and Obstructive Sleep Apnea (OSA). Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. Research to define patient characteristics more clearly for OA acceptance, success, and adherence is needed.

Obstructive sleep apnea syndrome: how should the dental surgeon proceed?

“…The main results were the improvement of clinical signs and symptoms, particularly in terms of the patient's daytime sleepiness and lack of concentration, and the reports of loud snoring made by his wife. The initial AHI of 17.6, representing a moderate level of apnea, fell to 4.1 (normal < 5 events/h), and the saturation of oxyhemoglobin rose from 89% to 90%, remaining practically stable, as demonstrated by the second polysomnograph with the device in position, a practice also recommended by AASM 16 .…”

“…According to AASM, the treatment goals for patients with apnea are resolution of the clinical signs and symptoms of apnea and normalization of AHI and blood oxygen saturation 16 . In this case, the main objectives described above were achieved.…”

“…According to the results of Almeida et al 30 , IODs induced teeth movement but no craniofacial skeletal changes. In 2005, because of existing concerns regarding adverse events, the Standards of Practice Committee of AASM published practical guidelines for treatment using IODs in patients with obstructive sleep apnea, in which they recommended follow-up every 6 months during the first year of treatment and annually thereafter 16 . According to these practical guidelines, the purpose of follow-up is to monitor adherence, evaluate deterioration of the device, adjust the device, assess the health of the structures of the mouth and the integrity of the occlusion, and determine whether the signs and symptoms of apnea have worsened.…”

“…It consists of a nasal mask connected to a motor that pumps air at a positive and continuous pressure, opening UA and preventing the collapse of the pharyngeal tissues. IODs are a relatively recent development, being indicated more often for mild to moderate cases of OSAS 2,[16][17][18][19] .…”

Horlama Ve Obstrukti̇f Uyku Apnesi̇ Tedavi̇si̇nde Oral Aparey Kullanimi

“…FDA, horlama ve apne tedavisi için TRD"yi onaylamış-tır 37 (Resim 3). Oral aparey tedavisi görecek olan hastalar için American Sleep Disorders Dental Society (ASDA) bir tedavi protokolü hazırlamıştır 31,[38][39][40][41] . Bu protokole göre: 1) Hastanın dental ve medikal anamnezi alınır.…”