SLEEP APNEA | Oral Appliances

Abstract

Oral appliances (OAs) are prescribed for the treatment of snoring and mild/moderate obstructive sleep apnea–hypopnea (OSAH). In general, OAs increase the size of the upper airway by advancing either the mandible or the tongue. Mandibular advancement OAs are the most widely used type of OAs. These require at least eight teeth in each of the maxillary and mandibular arches, and the degree of mandibular advancement can be specified and subsequently adjusted. There is increasing evidence that OAs improve sleepiness, blood pressure, and indices of sleep disordered breathing. However, continuous positive airway pressure (CPAP) has been shown to be more effective than OAs in improving sleepiness, health status, and indices of sleep disordered breathing and remains the primary treatment for OSAH. Current guidelines recommend OAs for selected patients with mild OSAH and normal daytime alertness. Furthermore, OAs are the best alternative treatment for patients with OSAH who are unwilling or unable to comply with CPAP therapy. OA therapy may also be indicated as an adjuvant to CPAP when the patient is away from home or without electrical power. OA therapy should be supervised by both medical and dental specialists with a major interest in the management of sleep disordered breathing. They should monitor patients following initiation of OA therapy to allow for appliance adjustment and change of OSAH symptoms and severity.