ORAL APPLIANCES FOR THE TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP-APNEA - A REVIEW

This paper, which has been reviewed and approved by the Board of Direc tors of the American Sleep Disorders Association, provides the backgro und for the Standards of Practice Committee's parameters for the pract ice of sleep medicine in North America. The 21 publications selected f or this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper a irway by changing the posture of the mandible and tongue. Despite cons iderable variation in the design of these appliances, the clinical eff ects are remarkably consistent. Snoring is improved and often eliminat ed in almost all patients who use oral appliances. Obstructive sleep a pnea improves in the majority of patients; the mean apnea-hypopnea ind ex (AHI) in this group of patients was reduced from 47 to 19. Approxim ately half of treated patients achieved an AHI of < 10; however, as ma ny as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on br eathing. Limited follow-up data indicate that oral discomfort is a com mon but tolerable side effect, that dental and mandibular complication s appear to be uncommon and that longterm compliance varies from 50% t o 100% of patients. Comparison of the risk and benefit of oral applian ce therapy with the other available treatments suggests that oral appl iances present a useful alternative to continuous positive airway pres sure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.