Oral Appliances for Obstructive Sleep Apnoea

Royal Surrey County Hospital, Guildford, Surrey, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 4(1):CD004435. DOI: 10.1002/14651858.CD004435.pub3
Source: PubMed


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.

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    • "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). "
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    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.
    Full-text · Article · Jan 2014 · Bioscience Horizons
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    • "In a recent study [24], 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 [40] [41] [42]. 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. "

    Full-text · Dataset · Dec 2012
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    • "Recently, it has been reported that the MAS is relatively well tolerated even in patients with a previous temporomandibular disorder (Perez et al., 2012) and approximately 56–70% of OSA patients beginning MAS therapy tolerate the appliance and their symptoms diminish (Lim et al., 2004; Kushida et al., 2005) The most crucial factor for the success rate of MAS treatment is the quantity of mandible advancement (Hoffstein, 2007). "
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    ABSTRACT: The treatment of choice in obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). Mandible advancement splint (MAS) offers an option for patients with mild or moderate OSA, who refuse or are unable to tolerate CPAP. The aim of the study was to find predictive factors in OSA for MAS therapy. The study group comprised 96 consecutive OSA patients who were sent for MAS therapy during 2008. Data were collected on the patients' general and dental condition, diagnosis, and treatment for OSA. Panoramic and cephalometric radiographs were analysed. The treatment compliance rate and problems with the use of the MAS were recorded. This rate was 57% and the significant affecting factors were protrusion of the mandible with MAS during the adaptation to the appliance as well as shorter maxillary and mandible lengths. The compliance of the MAS therapy was best in patients with short maxilla and mandible, which should be taken into consideration when planning MAS therapy for OSA patients. Finally, a sleep study should be part of the follow-up in this patient population.
    Preview · Article · Nov 2012 · The European Journal of Orthodontics
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