Current evidence has not demonstrated that oral appliances are as effective as continuous positive airways pressure in the treatment of obstructive sleep apnoea-hypopnoea. Sleep apnoea is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to a variety of symptoms including excessive daytime sleepiness. The current first choice therapy is continuous positive airways pressure that keeps the upper airway patent during sleep. However, this treatment can be difficult for patients to tolerate and comply with on a long-term basis. Oral appliances have been proposed as an alternative to continuous positive pressure therapy. They are designed to keep the upper airway open by either advancing the lower jaw forward or by keeping the mouth open during sleep. This review found that there was insufficient evidence to recommend the use of oral appliances as first choice therapy for sleep apnoea. When an active oral appliance was compared with an inactive oral appliance, there were improvements in daytime sleepiness and apnoea/hypopnoea severity. However, oral appliances proved less successful than continuous positive pressure in decreasing sleep disordered breathing. When oral appliances were effective in treating sleep apnoea it was preferred to continuous positive pressure by some patients. Oral appliances may be more effective than corrective upper airway surgery.
"It is similar to a mouthguard that when fitted to the teeth pulls the lower jaw forward. This increases the area and support in the upper airway (Lim et al., 2006). MAS is currently regarded as a second-line therapy for OSA, because it only completely alleviates OSA in 40% of patients (Sutherland and Cistulli, 2011). "
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnoea (OSA) is a leading yet often undiagnosed cause of daytime sleepiness. It affects between 3 and 7%
of the adult population, and the prevalence is expected to increase due to the obesity epidemic and ageing population. OSA
is a sleep-related breathing disorder in which the airway completely (apnoea) or partly closes (hypopnea) during sleep at
the end of expiration. This can lead to decreases in blood oxygen saturation and sleep fragmentation. Those who suffer with
OSA are often unaware of their symptoms. Severe, untreated OSA can have serious implications such as an increased risk of
cardiovascular disease, motor vehicle accidents, poor neurocognitive performance and increased mortality. Many patients are
prescribed continuous positive airway pressure (CPAP) as a treatment, but compliance with CPAP is often low. We briefly review
the diagnosis and prognosis for obstructive sleep apnoea. But the main focus of our review is the critical evaluation of the
numerous treatment strategies available for sleep apnoea as a multi-comorbid and multi-factorial condition. We also highlight
areas that need further research.
"In a recent study , we have demonstrated that lifestyle intervention with early weight reduction is an effective and viable treatment option for OSA, and should be considered as a first-line treatment for all patients when linked with obesity. Mandibular advancement devices (MADs) have also been found to be beneficial in patients with mild-to-moderate OSA   . It is justifiable to assume that the observations of the present study that normal-weight patients with mild SDB have more frequently abnormal occlusal and craniofacial findings would present a favorable basis for a successful MAD treatment in this group of patients. "
"Standard treatment with continuous positive airway pressure (CPAP) is highly efficacious for OSAS but adherence to the treatment limits its overall effectiveness . Oral appliance therapy is a viable alternative in the treatment of OSAS, especially in the mild and moderate cases and in patients unwilling or unable to tolerate CPAP . Generally, oral appliances aim at enlarging the upper airway during sleep by holding the mandible in a forward and downward position . "
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. MATERIALS AND METHODS: As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. RESULTS: Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (-1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (-0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β) = -0.02, 95 % confidence interval (-0.04 to -0.00)]. CONCLUSIONS: Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. CLINICAL RELEVANCE: Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
Anouk A M T Donners, Marilou D P Tromp, Johan Garssen, Thomas Roth, Joris C Verster
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