SLEEP - Article Abstract

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SLEEP - Article Abstract

Volume :	18
Issue :	06
Pages :	501-510

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Oral Appliances For The Treatment Of Snoring And Obstructive Sleep Apnea: A Review

^*Wolfgang Schmidt-Nowara, ^†Alan Lowe, ^‡Laurel Wiegand, ^§Rosalind Cartwright, ^║Francisco Perez-Guerra and ^¶Stuart Menn

^*Pulmonary Division, Department of Medicine, University of New Mexico, Albuquerque, NM; ^†Department of Clinical Dental Sciences, University of British Columbia, Vancouver, British Columbia, Canada; ^‡Department of Medicine, Pulmonary/Critical Care Division, Penn State College of Medicine, Hershey, PA; ^§Sleep Disorders Service and Research Center, Rush-Presbyterian-St. Luke's Medical Center, Rush University, Chicago, IL; ^║Division of Pulmonary Disease, Scott and White Clinic, Temple, TX; and ^¶Division of Sleep Disorders, Scripps Clinic, La Jolla, CA

Summary: This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.
Citation: Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. An American Sleep Disorders Association Review. SLEEP 1995;18:501-10