Principles of Oral Appliance Therapy for the Management of Snoring and Sleep Disordered Breathing

Department of Oral Biological and Medical Sciences, The University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada.
Oral and maxillofacial surgery clinics of North America (Impact Factor: 0.58). 11/2009; 21(4):413-20. DOI: 10.1016/j.coms.2009.07.002
Source: PubMed

ABSTRACT Oral appliance (OA) therapy for snoring, obstructive sleep apnea, or both is simple, reversible, quiet, and cost-effective and may be indicated in patients who are unable to tolerate nasal continuous positive airway pressure (nCPAP) or are poor surgical risks. OAs are effective in varying degrees and seem to work because of an increase in airway space, the provision of a stable anterior position of the mandible, advancement of the tongue or soft palate, and possibly a change in genioglossus muscle activity. This article provides a detailed clinical protocol and titration sequence for OAs, because this clinical procedure is often not well understood by practitioners new to the field. Prediction of treatment success is addressed, OA treatment is compared with surgery and nCPAP, OA compliance is described, and the possible adverse effects associated with this type of therapy are discussed.

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    ABSTRACT: Objectives: The aim of this study is to better understand patients' perspectives and preferences about treatment with continuous positive airway pressure (CPAP) and oral appliance (OA) devices for obstructive sleep apnea. Methods: The current study used qualitative analysis of four focus group sessions with current CPAP and OA users. Twenty-two participants with OSA who currently use either CPAP or OA participated in the sessions at the University of British Columbia. Results: Five topics from the focus group sessions were descriptively analyzed using NVivo software: goals and expectations of treatment, benefits of treatment for bed partners, side effects and inconveniences of CPAP, side effects and inconveniences of OA, and factors impacting treatment choice. In order of most to least frequently mentioned, patients expressed six expectations of treatment: improved health, apnea elimination, improved sleep, reduced fatigue, reduced snoring, and bed-partner benefits. The most to least mentioned factors impacting treatment choice were device effectiveness, transportability, embarrassment, and cost. Conclusions: This qualitative study showed that many factors impact patients' experience with their treatment device and that their treatment needs are not only physical but also relate to their lifestyle. This preliminary study provides treatment characteristics and attributes necessary to develop a quantitative questionnaire study, to assist in the selection of therapy, weighing the relative importance of patient and OSA treatment characteristics on treatment preference and adherence. Matching therapy to patient preferences may help identify the most appropriate treatment, and this may achieve greater likelihood of adherence.
    Sleep And Breathing 07/2012; 17(2). DOI:10.1007/s11325-012-0739-6 · 2.48 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) is characterized by repeated occlusion of the oropharyngeal airway during sleep and can have a significant impact on quality of life. In this article, I review the current knowledge of the physiological and pathological functions of the tongue and the genioglossus muscle, one of the upper airway dilatory muscles, in subjects with OSA when they are awake and asleep. Research findings clearly reveal that the genioglossus muscle has important functions in maintenance of upper airway patency and in the pathophysiology of obstructive sleep apnea. Despite extensive study of the functional properties of the genioglossus muscle and its motor units, the availability of OSA prevention and treatment measures remains limited. This review indicates there is a need for further study on more effective prevention and treatment strategies.
    Japanese Dental Science Review 08/2012; 48(2):71–80. DOI:10.1016/j.jdsr.2011.12.003
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    ABSTRACT: Study objectives: CPAP is used as the first-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Methods: Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Results: Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m² completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased significantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no significant differences in SAQLI between MAS and CPAP treatment, while ESS decreased significantly on MAS. MAS self-reported usage was correlated with treatment efficacy (r = 0.52; p < 0.05). Seventy-five percent of the patients reported being sufficiently satisfied with MAS to continue to use it as an alternative short-term therapy. Conclusions: MAS partially or completely reduced sleep disordered breathing in the majority of selected, successfully CPAP-treated severe OSA patients. Many patients can probably effectively use MAS as a short-term treatment alternative to CPAP.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 04/2013; 9(4):319-24. DOI:10.5664/jcsm.2576 · 3.05 Impact Factor
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