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

ArticleinOral and maxillofacial surgery clinics of North America 21(4):413-20 · November 2009with54 Reads
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.
    • "[87,88] Maxillomandibular surgeries Malpositioning of maxilla and mandible contribute to OSAS by reducing the posterior hypopharyngeal space. The role of surgery in the correction of such anatomical abnormalities is summarized in [62,71,72] Inadequate number of healthy teeth in upper and lower dental arch (at least 6‑10 teeth in each arch desirable) Periodontal diseases Patients with full dentures Limitation in forward protrusion of mandible and jaw opening Temporomandibular joint diseases OA: Oral appliance Better response is seen with: Evidence Quality C "
    Full-text · Dataset · May 2016 · Lung India
    • "Over the past few decades, bi-maxillary oral appliances (OAs) have become a management option for patients with primary snoring or mild to moderate OSAS [133]. OAs increase the upper airway space by pulling the mandible or tongue in an advanced position [134]. As a result, OAs reduce the number of obstructive events during sleep and restore fragmented sleep in association with improvement of clinical symptoms [133,135]. "
    Article · Jan 2016
    • "[62,63] Effects of oral appliances therapy Effects of OA therapy are summarized inTable 5. [61,63‑70] Contraindications to OA therapy. [62,71,72] Contraindications to OA therapy are summarized in Box 6. "
    [Show abstract] [Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) are subsets of sleep-disordered breathing. Awareness about OSA and its consequences among the general public as well as the majority of primary care physicians across India is poor. This necessitated the development of the Indian initiative on obstructive sleep apnea (INOSA) guidelines under the auspices of Department of Health Research, Ministry of Health and Family Welfare, Government of India. OSA is the occurrence of an average five or more episodes of obstructive respiratory events per hour of sleep with either sleep-related symptoms or co-morbidities or ≥15 such episodes without any sleep-related symptoms or co-morbidities. OSAS is defined as OSA associated with daytime symptoms, most often excessive sleepiness. Patients undergoing routine health check-up with snoring, daytime sleepiness, obesity, hypertension, motor vehicular accidents, and high-risk cases should undergo a comprehensive sleep evaluation. Medical examiners evaluating drivers, air pilots, railway drivers, and heavy machinery workers should be educated about OSA and should comprehensively evaluate applicants for OSA. Those suspected to have OSA on comprehensive sleep evaluation should be referred for a sleep study. Supervised overnight polysomnography is the "gold standard" for evaluation of OSA. Positive airway pressure (PAP) therapy is the mainstay of treatment of OSA. Oral appliances (OA) are indicated for use in patients with mild to moderate OSA who prefer OA to PAP, or who do not respond to PAP or who fail treatment attempts with PAP or behavioral measures. Surgical treatment is recommended in patients who have failed or are intolerant to PAP therapy.
    Full-text · Article · Jul 2015
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