Oral Appliance Treatment for Obstructive Sleep Apnea: A Retrospective Study

Abstract

Obstructive sleep apnea (OSA) is prevalent among middle-aged adults; it has been proven to be related to cardiovascular events and could possibly cause traffic accidents. Although continuous positive airway pressure applied to the upper airway via a nasal mask (nasal CPAP) could effectively eliminate the obstruction during sleep, its cumbersome nature and high cost have prompted clinicians to seek alternative treatments. Oral appliances have become an effective method in the treatment of OSA. In this study, we retrospectively investigated the effects of oral appliance (Bionator) treatment on 74 patients with sleep-related problems. Medical charts were reviewed and the data of the patients' disease characteristics and treatment responses were extracted and analyzed. The objective parameters, sleep efficiency and respiratory disturbance index (RDI), were significantly improved after the use of the oral appliance (80.8±13.8 vs. 87.8±7.8, p=0.002 and 29.9±21.6 vs. 17.4±19.1, p＜0.001, respectively). Oral appliance treatment also altered the distribution of disease severities toward a simple snoring and mild OSA predominance. The majority of patients had moderate to good responses in all 3 severity groups. No particular predictive factor could be found for treatment response. The subjective parameters of snoring and excessive daytime sleepiness were also improved by oral appliance therapy: Snoring Outcomes Survey score (SOS): 29.2±5.5 vs. 20.3±7.0, p＜0.001; Spouse and Bed Partner Survey score (SBPS): 12.2±2.6 vs. 6.8±3.6, p＜0.001; Epworth Sleepiness Scale (ESS): 9.2±5.0 vs. 5.9±4.2, p=0.004). There was no serious adverse effect. The most common adverse effects reported were temporo-mandibular joint discomfort (55.4%), followed by sleep disturbance (29.7%) and pain (17.6%). Conclusion: Oral appliances are effective for OSA of all severities with few complications. Oral appliances could be an inexpensive and convenient alternative for nasal CPAP in OSA treatment.