Review of oral appliances for treatment of sleep-disordered breathing

Abstract

Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/ hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56-68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.

Aparelhos orais de protrusão mandibular ? IAH, eficiência do sono, sono REM e oxigenação de usuários

“…The greater the severity of the study group, the lower the level of oxygen saturation, with the lowest average (77.2%) of the severe patients, as noted in Table Sleep in the study, this index proves to be an important indicator of the severity of apnea. Among the treatment options for OSAHS already established in the literature, we have the main therapeutic measures of sleep hygiene, uvulopalatopharyngoplasty surgery, surgery of mandibular and maxillary advancement, the use of CPAP devices and the use of oral appliances protrusion (AOPM) 2,[15][16][17][18][19] . The mandibular protrusion appliances have been consolidated as an alternative treatment to CPAP, with no consensus yet on its indication, but its statement is mainly in cases of low and medium gravity 7,20 .…”

“…In 30 months, 56-68% of patients continue to use oral appliance. There are still doubts about the effectiveness of oral appliances, but its use in the treatment of apnea of medium severity has received great attention and acceptability 7,18,21 .…”

Positive airway pressure and electrical stimulation methods for obstructive sleep apnea treatment: a patent review (2005 – 2014)

“…Surgical (nasal, oropharyngeal and hypopharyngeal procedures, maxillomandibular advancement, and hyoid suspension), medical (CPAP, custom-made oral appliances), behavioral (weight loss, positional therapy), and pharmacological (supplemental oxygen, modafinil) approaches are currently the main alternatives for OSAHS treatment [3,6,20,35,36]. Table 1 summarizes the main alternatives currently available for OSAHS treatment, their advantages and limitations.…”

Síndrome da Apneia Obstrutiva do Sono e Doenças Cardiovasculares

“…Os aparelhos intraorais são indicados pela AASM para pacientes com SAOS leve a moderada e para pacientes com SAOS grave que não tiveram sucesso ou não toleraram o CPAP 63 . Podem ser divididos em dispositivos de avanço temporário da mandíbula e de tração da musculatura lingual, que aumentam a passagem de ar na VAS.…”