Oral appliance design for treatment of oral sleep apnea- advantages, side effects, combined therapy and latest modifications - a review

Although continuous positive airway (CPAP) pressure therapy is the most recommended treatment for patients with obstructive sleep apnea (OSA) not all patients are able to remain compliant with this form of treatment. Some complain of claustrophobia, dry nasal passages, skin irritation from masks, difficulty tolerating pressurized air, and accidentally removing the mask while tossing at night. For patients like these, an alternative to CPAP therapy may be recommended, and depending on the level of severity of their disorder, may benefit from a substitute treatment such as an oral dental appliance. Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment (Sutherland et al., 2014). The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment (1). Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography (Sutherland et al., 2014). Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA (Sutherland et al., 2014)