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An evidence-based review of literature from 1995 to 2006 regarding use of oral appliances in the treatment of snoring and obstructive sleep apnea syndrome yielded the following observations. It should be noted that the criterion for successful treatment differed from study to study, with the most stringent defining success as a reduction to less than five respiratory events per hour of sleep, and the most liberal being a reduction of 5- percent or more from the baseline AHI.

Taking the results as a whole, oral appliance therapy provided a success rate of:

  • 42 percent for an AHI of <5
  • 52 percent for an AHI <10
  • 65 percent for a reduction of AHI > 50 percent

Among the variables that contribute to the effectiveness of oral appliances are:

  • Severity of the sleep apnea: The lower the AHI the greater the efficacy of oral appliances.
  • Amount of mandibular protrusion: The greater the protrusion, the greater the efficacy of the oral appliance.
  • The presence of positional sleep apnea: a higher supine AHI and lower lateral AHI provides a higher efficacy of oral appliances.
  • Body Mass Index (BMI): A higher BMI results in a lower efficacy of the oral appliance and less likelihood there will be a marked difference in severity by sleep position.

Mechanism of action of the oral appliance

  • Increases cross sectional airway size, particularly in the velopharynx via anterior movement of the mandible
  • Increases upper airway tone
  • Greater amount of mandibular protrusion for increased efficacy in reducing AHI.

Treatment Adherence

  • 77 percent of nights at one year
  • Well tolerated with minor side effects (excessive salivation, muscle and tooth discomfort and occasional joint discomfort). These improve over time.

Oral appliances are indicated for use in:

  • Patients with mild to moderate OAS who prefer them to continuous positive airway pressure (CPAP) therapy.
  • Severe OSA for patients who do not respond to, or are not appropriate candidates for CPAP
  • Patients who fail treatment attempts with CPAP
References
Bishop B, Verrett R, Girvan T; lngmundson  P. Crossover Study Comparing Two Oral Appliance Designs for Treatment of Obstructive Sleep Apnea. At: American Academy of Dental Sleep Medicine  Annual Meeting. San Antonio, TX; 2010.
Chung JW, Enciso R, Levendowski Dl, Westbrook  PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. In: Oral Surg Oral Med Oral Pathol Oral Radio/ Endod. 2010 May; 109(5}:724-31.
McLornan  P, Verrett R, Girvan T; lngmundson  P. Evaluation of Obstructive Sleep Apnea Patients’ Oral Appliance
Titration Protocols. At: American Academy of Dental Sleep Medicine  Annual Meeting. San Antonio, TX; 2010. Oral Appliances: How They Work
Bendet; SD. Oral appliance therapy for sleep-related breathing disorders. In: Elseviet; Operative Techniques in Otolaryngolog{2012) 23.72-78
*Holley AB.Lettieri CJ.Shah AA. Efficacy of an Adjustable  Oral Appliance and Comparison to Continuous Positive Airway Pressure for  the Treatment of Obstructive Sleep Apnea Syndrome. In: Chest DO/ 10.1378/chest.10-2851.June 2.2011
 
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