Oral appliances for obstructive sleep apnoea
ABSTRACT Obstructive sleep apnoea-hypopnoea (OSAH) is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure (CPAP) is the primary treatment for OSAH , but many patients are unable or unwilling to comply with this treatment. Oral appliances (OA) are an alternative treatment for OSAH.
The objective was to review the effects of OA in the treatment of OSAH in adults.
We searched the Cochrane Airways Group Specialised Register. Searches were current as of June 2005. Reference lists of articles were also searched.
Randomised trials comparing OA with control or other treatments in adults with OSAH .
Two authors independently extracted data and assessed trial quality. Study authors were contacted for missing information.
Sixteen studies (745 participants) met the inclusion criteria. All the studies had some shortcomings, such as small sample size, under-reporting of methods and data, and lack of blinding. OA versus control appliances (six studies): OA reduced daytime sleepiness in two crossover trials (WMD -1.81;95%CI -2.72 to -0.90), and improved apnoea-hypopnoea index (AHI) (-10.78; 95% CI-15.53 to -6.03 parallel group data - five studies). OA versus CPAP (nine studies): OA were less effective than CPAP in reducing apnoea-hypopnoea index (parallel group studies: WMD 13 (95% CI 7.63 to 18.36), two trials; crossover studies: WMD 7.97; (95% CI 6.38 to 9.56, seven trials). However, no significant difference was observed on symptom scores. CPAP was more effective at improving minimum arterial oxygen saturation during sleep compared with OA. In two small crossover studies, participants preferred OA therapy to CPAP. OA versus corrective upper airway surgery (one study): Symptoms of daytime sleepiness were initially lower with surgery, but this difference disappeared at 12 months. AHI did not differ significantly initially, but did so after 12 months in favour of OA.
There is increasing evidence suggesting that OA improves subjective sleepiness and sleep disordered breathing compared with a control. CPAP appears to be more effective in improving sleep disordered breathing than OA. The difference in symptomatic response between these two treatments is not significant, although it is not possible to exclude an effect in favour of either therapy. Until there is more definitive evidence on the effectiveness of OA in relation to CPAP, with regard to symptoms and long-term complications, it would appear to be appropriate to recommend OA therapy to patients with mild symptomatic OSAH, and those patients who are unwilling or unable to tolerate CPAP therapy. Future research should recruit patients with more severe symptoms of sleepiness, to establish whether the response to therapy differs between subgroups in terms of quality of life, symptoms and persistence with usage. Long-term data on cardiovascular health are required.
SourceAvailable from: Olivier M Vanderveken[Show abstract] [Hide abstract]
ABSTRACT: Sleep-disordered breathing covers a broad range of central, obstructive or mixed respiratory disturbances occurring or aggravating during sleep. Treatment recommendations depend upon the underlying path-ophysiology and severity of the disorder, and therapy should be tailored to the individual patient's needs. • Before starting specific medical therapy, applicability of general measures such as dietary interventions or abstinence of drugs should be considered. • Continuous positive airway pressure (CPAP) is the mainstay for treatment of moderate to severe obstruc-tive sleep apnoea, whereas the use of oral appliances has been proved beneficial for mild to moderate disease. • Surgical treatment of pharyngeal anomalies, retrogna-thia or obesity may be applied in selected cases with obstructive sleep apnoea. • Central sleep apnoea is a heterogeneous condition that first requires identification and treatment of any underlying disease processes. Symptomatic treat-ment comprises CPAP, bi-level PAP or adaptive servo-ventilation and oxygen supplementation. SUMMARY This chapter deals with different therapeutic approaches to sleep disturbances characterized by sleep-disordered breathing. General recommendations and conservative measures are crucial first steps in the management of sleep-disordered breathing. Pharma-cological agents have no major role in the treatment of obstructive sleep apnoea, but have certain indications in patients with central sleep apnoea, especially in those suffering from heart failure. Treatment with oral devices has become a cornerstone in the management of patients with mild to moderate obstructive sleep apnoea, and may also be helpful in selected patients with severe disease. Positive airway pressure contin-ues to be the mainstay of treatment of obstructive sleep apnoea patients with moderate to severe disease. Bi-level positive airway pressure is indicated as a therapy for respiratory failure (alveolar hypoventilation with hypercapnia). Adaptive servo-ventilation has been introduced as a specific treatment of cardiac patients with central sleep apnoea and Cheyne–Stokes respi-ration, but may also be used in other conditions associated with central sleep apnoea. Surgery of the upper airways or of the maxillomandibular skeleton is performed in selected obstructive sleep apnoea patients. Bariatric surgery is a therapy indicated in morbidly obese patients with obstructive sleep apnoea who fail to lose weight with conservative measures such as hypocaloric diet and exercise training.Sleep Medicine Textbook, first edition edited by Claudio Bassetti, Zoran Dogas, Philippe Peigneux, 01/2014: chapter D.5 Treatment of respiratory sleep disorders: pages 259-274; European Sleep Research Society., ISBN: 9781119038931
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ABSTRACT: Resumo A síndrome da apneia obstrutiva do sono (SAOS) é um distúrbio respiratório do sono que se caracteriza por eventos recorrentes de obstrução das vias aéreas superiores durante o sono, associados aos sinais e sintomas clínicos. Os aparelhos orais são uma opção de tratamento clínico do ronco e da SAOS, que têm sido apontados, cada vez mais, como uma proposta adequada. Os aparelhos podem ter desenhos variados e mantêm a mandíbula posicionada para a anterior durante o sono, sendo os mais utilizados nos tratamentos os que têm uma maior taxa de sucesso. Objetiva-se por meio deste artigo apresentar o aparelho PLP (placas lateroprotrusivas) que consiste em um dispositivo intrabucal que possui características pre-conizadas para o tratamento da SAOS e do ronco, aliadas ao baixo custo e à facilidade de confecção. Recomenda-se, inicialmente, que o paciente seja avaliado para fins de diagnóstico e indicação do tratamento por médico especialista em Medicina do Sono. Para implementar a terapia com aparelho intrabucal, o profissional deve estar familiarizado com este tipo de abor-dagem e apresentar conhecimento sobre os aspectos relacionados aos distúrbios respiratórios do sono. A atuação deve ser multidisciplinar, envolvendo a interação da Odontologia com as especialidades da Medicina relacionadas ao problema, buscando o sucesso do tratamento e evitando-se a desvalorização da terapia com aparelhos intrabucais. Descritores: Apneia do sono tipo obstrutiva, ronco, avanço mandibular. Abstract The obstructive sleep apnea syndrome (OSAS) is a sleep related breathing disorder characterized by recurrent events of upper airway obstruction during sleep, associated with clinical signs and symptoms. Oral appliances are an option for clinical treatment of snoring and sleep apnea syndrome, and have been pointed, increasingly, as a suitable treatment option. Apparatus jaw positioners may have various designs and maintain the jaw positioned protruded during sleep. These are the most commonly used treatments, and have higher success rate. The present work aims at presenting the PLP
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ABSTRACT: To conduct an overview of existing systematic reviews concerning management of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) with mandibular advancement splint (MAS) and assess their methodological quality. PubMed and relevant Cochrane Library databases (CDSR, DARE, HTA) searches were performed (09.13) to identify systematic reviews investigating the response of adults with OSAHS to MAS therapy. The methodological quality of the included systematic reviews was assessed using AMSTAR, a validated tool for assessing quality. Eight systematic reviews, four incorporating meta-analyses, were identified evaluating both objective and subjective outcome measures. The effectiveness of MAS therapy was compared to no treatment (n = 1), non-active appliance (n = 6), continuous positive airway pressure (CPAP; n = 5), surgical intervention (n = 3) and a different MAS intervention (n = 4). The quality of the reviews was variable (median = 7, range = 3 to 11), with only two of higher quality (AMSTAR scores >10), one of them a Cochrane review. In this high quality and current review, the overall (pooled) effects for comparison of MAS therapy with inactive appliances, revealed significant benefits of MAS therapy in terms of both daytime sleepiness and objective apnoea-hypopnoea index (AHI) outcomes. In general, the results from the higher quality reviews concerning the effectiveness of MAS therapy for OSAHS highlight the ability of the intervention to improve OSAHS. Current reporting guidelines for systematic reviews (e.g. PRISMA) and sources of high-quality existing reviews should be closely followed to enhance the validity and relevance of future reviews.Sleep And Breathing 03/2015; DOI:10.1007/s11325-015-1148-4 · 2.87 Impact Factor