Oral appliances in the treatment of obstructive sleep apnea
Faculty of Medicine and Health Sciences
Minerva pneumologica / Societa di Pneumologia. - Torino
, p. 237-245
University of Antwerp
Mandibular advancement devices (MAD) are currently the most widespread and evaluated type of oral appliance used to treat obstructive sleep apnea (OSA). Recent studies suggest that MAD therapy is an effective treatment for OSA in clinical practice. Compared to MAD, continuous positive airway pressure (CPAP) reduces OSA severity more efficiently, but overall CPAP effectiveness, when adjusted for the limited patient and partner acceptance, remains relatively low. Oral appliance therapy can be indicated in patients with mild to moderate OSA who prefer oral appliance therapy to CPAP, and these patients that do not respond to, do not comply with, or refuse CPAP therapy. Oral appliances are also indicated in primary snorers, and in patients with a history of persistent OSA after upper airway surgery. Compared to custom-made devices, prefabricated oral devices are less effective, and cannot be recommended to be prescribed in clinical routine practice. Titratable MAD treatment offers the advantage of the possibility of progressive titration of the mandibular protrusion towards a most effective position. However, concerning the titration protocol, currently, no consensus exists. Up to this date, prediction of treatment outcome with oral appliance therapy for OSA lacks consistency, and, prospective validation studies are needed. The contraindications for oral appliance therapy are mainly dental. Long-term compliance during MAD treatment is related to treatment outcome and patients comfort. As long as there is no objective measurement of oral appliance compliance available, caution is needed in the interpretation of self-reported oral appliance compliance.