Oral appliances for obstructive sleep apnea

Abstract

ImportanceObstructive sleep apnea (OSA) is a major public health issue that can have serious medical consequences. Although continuous positive airways pressure (CPAP) is currently the first-line treatment for OSA, there is increasing evidence on the effectiveness of oral appliances (OAs) which show higher treatment adherence compared with CPAP. This review focuses on indications, effectiveness and side effects of treatment with OAs in adult OSA patients. The role of dentists in the multidisciplinary diagnosis and management of OSA is also discussed and the most up-to-date scientific evidence for an evidence-based clinical decision-making process is summarized. ObservationsQualified dentists in dental sleep medicine can screen patients for OSA using questionnaires and evaluating the presence of anatomic risk factors during routine examinations. Sleep physicians confirm the diagnosis of OSA, determine whether treatment is indicated and may recommend OAs. Qualified dentists evaluate patients for suitability of OAs and begin therapy with the proper device. A collaborative follow-up should be performed during treatment, with patients being periodically monitored by sleep physicians for objective sleep testing and, also, by qualified dentists for OA adjustment and management of any side effect. Conclusion and RelevanceCustom-made and titratable OAs are indicated for adult OSA patients who do not tolerate or who are not good candidates for CPAP. A multidisciplinary approach allows to establish the least possible amount of mandibular advancement while achieving the highest reduction of OSA severity, thus optimizing the treatment effectiveness, reducing the occurrence of side effects and decreasing the risk of treatment discontinuation.