Treatment of Sleep Apnea with Oral Appliaaces is a well accepted first line approach for mild to moderate sleep apnea. Long term outcome studies in patients with cardiovascular disease are equal to treatment with CPAP and preferred by 90% of patients.
A new study has confirmed these findings in an Asian Population. This was the first studyin an Asian population. As expected the Mandibular Advancement Appliance worked well for the majority of patients. Please see Pub Med abstract below:
Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability.
To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment.
Prospective, nonrandomized, before-after study.
Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint(TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter.
Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects.
This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.
LEVEL OF EVIDENCE:
4 Laryngoscope, 2014.
© 2014 The American Laryngological, Rhinological and Otological Society, Inc.
Asian; Obstructive sleep apnea; Somnoguard; Thai; mandibular advancement splint; oral appliances; quality of life; thermoplastic
[PubMed – as supplied by publisher]