Abstract
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.
Highlights
Obstructive sleep apnea (OSA) is an increasingly common disorder, affecting approximately17% of adult women and 34% of men [1]
The results indicate that combination therapy of mandibular advancement devices (MAD) and positional therapy leads to a higher therapeutic efficacy in patients with a residual positional OSA under MAD
Compared to one of the treatment modalities alone [99]. These findings suggest that when patients are unsuccessfully treated with MAD treatment, the presence of the positional OSA should be checked and combination therapy could be suggested in eligible patients
Summary
Obstructive sleep apnea (OSA) is an increasingly common disorder, affecting approximately. The main pathophysiological feature of OSA is repetitive narrowing (hypopnea) or closure (apnea) of the upper airway (UA) during sleep, causing intermittent hypoxia, intrathoracic pressure swings, sympathetic surges, and sleep fragmentation [2]. Due to these perturbations, OSA is linked to a range of harmful sequelae: excessive daytime sleepiness, fatigue, an impaired cognitive performance, a reduced quality of life, an increased risk of occupational and traffic accidents [3], metabolic disturbances [4], hypertension [5], cardio- and cerebrovascular morbidity, and OSA-related mortality [6].
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