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Oral Appliance Therapy for Sleep-Disordered Breathing

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Contemporary Oral Medicine

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Abstract

Obstructive sleep apnea (OSA) is characterized by repetitive obstruction of the upper airway during sleep, resulting in sleep fragmentation and nocturnal oxygen desaturation. As a result, patients may present with signs and symptoms of daytime sleepiness, neurocognitive impairment, and cardiovascular morbidity and mortality. Mandibular advancement appliances (oral appliance mandibular, OAm) are recommended for patients with mild-to-moderate OSA, and for those with severe OSA, where continuous positive airway pressure is refused or not tolerated. The mechanism of action of OAm is based on holding the mandible in a protrusive position and hence reducing pharyngeal collapsibility during sleep. Two-thirds of patients show a minimum of 50% reduction in the apnea-hypopnea index (AHI) with OAm treatment. Further, OAm have been shown to have a positive effect on blood pressure and endothelial function that are markers of cardiovascular health. Despite OAm being inferior in therapeutic efficacy to CPAP in reducing the AHI, its higher compliance might translate to similar adjusted AHI and clinical effectiveness. There are side effects with OAm use, such as bite changes and jaw pain; however, most side effects are transient and rarely significant in the long term.

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Authors and Affiliations

  1. Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia

    Joachim Ngiam, Kate Sutherland & Peter Cistulli

  2. Charles Perkins Centre and Northern Clinical School, University of Sydney, Sydney, NSW, Australia

    Kate Sutherland & Peter Cistulli

  3. UWA Dental School and Oral Health Centre of Western Australia, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia

    Ramesh Balasubramaniam

  4. Department of Orthodontics, Umeå University, Umeå, Sweden

    Marie Marklund

  5. Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, BC, Canada

    Fernanda Almeida

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  1. Joachim Ngiam
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  2. Kate Sutherland
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  3. Ramesh Balasubramaniam
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  4. Marie Marklund
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  5. Fernanda Almeida
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  6. Peter Cistulli
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Editors and Affiliations

  1. UWA Dental School and Oral Health Centre of Western Australia, Faculty of Health and Medical Sciences University of Western Australia, Perth, WA, Australia

    Camile S. Farah

  2. UWA Dental School and Oral Health Centre of Western Australia, Faculty of Health and Medical Sciences University of Western Australia, Perth, WA, Australia

    Ramesh Balasubramaniam

  3. Oral Anatomy, Medicine, and Surgery Section Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne, Carlton, VIC, Australia

    Michael J. McCullough

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Ngiam, J., Sutherland, K., Balasubramaniam, R., Marklund, M., Almeida, F., Cistulli, P. (2019). Oral Appliance Therapy for Sleep-Disordered Breathing. In: Farah, C., Balasubramaniam, R., McCullough, M. (eds) Contemporary Oral Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-72303-7_43

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