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J Clin Sleep Med. 2014 Feb 15;10(2):215-27. doi: 10.5664/jcsm.3460.

Oral appliance treatment for obstructive sleep apnea: an update.

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Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia ; NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), University of Sydney and Woolcock Institute of Medical Research, Sydney, Australia.
Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium ; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
General Oral Care, Kyushu University Hospital, Fukuoka, Japan.
Department of Orthodontics, Faculty of Medicine, Umea University, Umea Sweden.
LUNAM University, Angers, France ; Department of Respiratory Diseases, Angers University Hospital, Angers, France ; INSERM U1063, Angers, France.
Stanford University, Stanford, CA.


Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.


Obstructive sleep apnea; adherence; effectiveness; mandibular advancement; oral appliance

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