Oral appliance therapy in sleep apnea syndromes: A review

Obstructive sleep apnea (OSA) can present serious health risks and must be diagnosed by a physician in conjunction with a sleep study. Of nonsurgical treatment alternatives, nasal continuous positive airway pressure (nCPAP) has been shown to be more effective than oral appliance therapy in improving respiratory disturbances. However, many patients initially refuse or cannot tolerate this treatment and randomized trials report patient preference for oral appliances. Since 1980, approximately 150 articles have been published on oral appliance therapy. This article is a review of case studies and randomized trials. Terminology, clinical procedures, and patient communication also are discussed as well as contraindications and complications of this treatment alternative. A 2001 review of 563 patients with different severities of OSA in 30 case studies since 1985 showed a reduction in the apnea-hypopnea index to < 10 in 61% of the sample. This report and other studies emphasize that some patients do not improve or become worse despite improvement of some symptoms, eg, snoring. Therefore, physicians must continue progress evaluations. Side effects are usually minor and transient although a small proportion of patients cannot tolerate this approach. It is not yet possible to predict the most advantageous appliance type for a particular patient. Recent randomized trials have shown that devices with a range of vertical openings are effective and adjustability seems to be a desirable feature. Although oral appliance treatment may last for many years, patients must be informed that these devices require periodic replacement, which may be a financial consideration should insurance coverage not be available.