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
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.
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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.