VALUE OF INTRAORAL AND EXTRAORAL DEVICES IN THE TREATMENT OF OBSTRUCTIVE SLEEP-APNEA AND SNORING

aBackground: Recently intra- and extraoral devices are increasingly us ed in order to treat obstructive sleep apnea (OSA) and snoring. We exa mined the value of some devices according to the literature and our ow n results. Patients and Methods: The mandibular advancing devices aim at increasing upper airway diameter. The active part of the tongue ext ending device (SnorEx(R)) is a stamp connected to a piston which exert s pressure at the base of the tongue causing its forward displacement; we studied 23 patients. The principle of an optically stimulating sys tem (''eye-cover'', Snore-Stop(R)) consists of a microphone and light diods which are integrated in the eye-cover. Alter detecting acoustic signals (for example snoring) optical stimuli are generated in front o i the eyes, which are thought to induce arousals causing a change of b ody position and the reduction of the snoring and apneas; we measured 24 patients. The principle of the tongue-retainer (Snore-Master(R)) is the fixation oi the tongue in a ventral position, which is thought to enlarge the mesopharyngeal area; we studied 14 patients. The nose pla ster (Breathe-Right(R)) contains an elastic spine that pulls the alae nasi cranial. This manipulation is thought to increase the diameter of the nostril and reduce the airway resistance. We measured 30 patients with obstructive sleep apnea and 20 snoring subjects without obstruct ive sleep apnea. Results: Regarding the mandibular advancing due to di fferent appliance designs and study protocols variable success rates h ave been documented. In patients with mild to moderate obstructive sle ep apnea a reduction oi the sleep related breathing disorder could be shown. Non compliance (NC) to the tongue extending device was 75% (17/ 23). Non-compliance-patients were characterized by unacceptable local- side-effects of the prosthesis, lacking improvement of symptoms and of the respiratory disturbance index. Both tongue-retainer and extensor are characterized by a high incidence of local side effects. Neither t he eye-cover nor the nose plaster could improve the: severity oi obstr uctive sleep apnoe or snoring. In contrast to another study we could n ot show a significant effect of the tongue-retainer. Conclusions: Neit her the nose plaster nor the optical stimulating device influenced the : degree of obstructive sleep apnea and snoring. There are conflicting data regarding the tongue retainer. The high rate of non-compliant su bjects and the low efficacy of the tongue extending prosthesis preclud es large-scale use of this treatment modality in patients with obstruc tive sleep apnea and snoring. In selected individuals suffering fi-om a mild to moderate degree of obstructive sleep apnea with CPAP-ineffic iency and -incompliance the mandibular advancing principle may be an t herapeutic alternative to CPAP.