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CPAP Therapy

Oral Appliance Therapy

Relative Effectiveness

CPAP Therapy

CPAP therapy is considered to be the gold standard for the treatment of obstructive sleep apnea (OSA). Patients who successfully use CPAP feel better rested, have less daytime  sleepiness, and  have improved  concentration and  memory. In addition, CPAP may potentially reduce the risks for heart problems such as high blood pressure. For maximum  benefit, CPAP should be used for at least 6-7 hours each night.

CPAP Patient

Common Side Effects of CPAP:

  • Gastric distension (air in the stomach)
  • Nasal Congestion
  • Eye Irritation
  • Sinus Irritation
  • Skin Irritation

Yet despite the potential effectiveness of CPAP therapy, the real-world effectiveness, also known as the mean alleviation of disease, provided by CPAP is lower than one might expect. This is due to the typically moderate to low compliance rates associated with this therapy.

Although  this is very effective, many OSA patients find CPAP is uncomfortable to wear, or are unable to tolerate the air pressures required for treatment. Studies show that  up to half of all patients who begin CPAP therapy will discontinue its use within the first three months, and long-term compliance drops into the range of 45 to 37 percent. Leakage, pressure from the mask and tightness of the straps, restricted  movement  while  sleeping, claustrophobia, and frequent traveling are all reasons that patients offer for why they cannot tolerate the CPAP mask straps and headgear.

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Oral Appliance Therapy

Oral Appliance Therapy (OAT) consists of a device that goes into the mouth and attaches to the teeth in order to bring the jaw forward at night. By bringing the jaw forward, the tongue is also brought forward, thereby opening up the back of the throat. The base of the tongue collapsing against the airway is the most frequent cause of obstruction, and by bringing the jaw forward this physically opens up the airway, which makes it easier to breathe. These appliances are well documented to be successful and most people adapt to them very well.

Oral Appliance Therapy

As a dentist, specially trained in treating snoring and sleep apnea, patients come to me because they want to avoid the CPAP mask, headgear, and straps. For 80 percent of those patients an oral appliance is effective in treating their snoring and getting them maximum medical improvement for their sleep apnea.

Because oral appliances are comfortable and easy to wear patients are very compliant (85 to 95 percent) and tend to use them every night, all night. If the patient can get maximum medical improvement with an oral appliance alone this is ideal. The patients seek out and readily accept this approach. Success is determined by a post-treatment sleep study.

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Relative Effectiveness of CPAP and OAT

The overall effectiveness of PCPA therapy has been studied and well-documented for a number of years. Until recently, however, it was difficult to make direct comparisons between the relative effectiveness of CPAP and OAT in real world-use, as number for compliance and time-of-use for the latter was largely anecdotal. More recently, the development of new sensing technologies have lead to studies that put more concrete numbers on a OAT’s overall effectiveness, based on a combination of compliance and effectiveness, as expressed in a total reduction in AHI.

Relative Effectiveness of CPAP and OAT

CPAP therapy is shown to remain in the mid-80 percent range for all OSA patients, but when compliance rates are factored in, a general-accepted number for mean alleviation of disease with CPAP is 50 percent. The effectiveness of OAT ranges from 70 to 85 percent among all OSA patients. But based on quantitative data, it now appears that OAT provides similar overall rates of mean disease alleviation (50-52 percent range).*

As more research on OAT is published, the parameters of this therapy are expanding. In the past, OAT was considered appropriate primarily for patients with mild to moderate OSA, (AHI <15, AHI 15-30). Increasingly, however, it is being seen as a viable first-line treatment for even severe cases in which CPAP seems inappropriate. In recognition of these facts, the American College of Physicians recently released new guidelines for OSA treatment that included the statement that: “The ACP recommends mandibular advancement devices for initial treatment of sleep apnea in patients who have adverse reactions to CPAP.”

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*Source: Objective Measurement of Compliance During Oral Appliance Therapy for Sleep-Disorder Breathing; Antwerp University Hospital, Vanderverken. European Respiratory Journal, 2000/16
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