Oral appliances for obstructive sleep apnoea
- 25 January 2006
- journal article
- research article
- Published by Wiley in Emergencias
- Vol. 2006 (1), CD004435
- https://doi.org/10.1002/14651858.cd004435.pub3
Abstract
Background Obstructive sleep apnoea‐hypopnoea (OSAH) is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal. Nasal continuous positive airway pressure (CPAP) is the primary treatment for OSAH , but many patients are unable or unwilling to comply with this treatment. Oral appliances (OA) are an alternative treatment for OSAH. Objectives The objective was to review the effects of OA in the treatment of OSAH in adults. Search methods We searched the Cochrane Airways Group Specialised Register. Searches were current as of June 2008. Reference lists of articles were also searched. Selection criteria Randomised trials comparing OA with control or other treatments in adults with OSAH . Data collection and analysis Two authors independently extracted data and assessed trial quality. Study authors were contacted for missing information. Main results Seventeen studies (831 participants) met the inclusion criteria. All the studies had some shortcomings, such as small sample size, under‐reporting of methods and data, and lack of blinding. OA versus control appliances (six studies): OA reduced daytime sleepiness in two crossover trials (ESS score ‐1.81; 95%CI ‐2.72 to ‐0.90), and improved apnoea‐hypopnoea index (AHI) (‐10.78 events/hr; 95% CI‐15.53 to ‐6.03 parallel group data ‐ five studies). OA versus CPAP (ten studies): There was no statistically significant difference in symptoms for either parallel or crossover studies, although OAs were less effective than CPAP in reducing apnoea‐hypopnoea index in parallel and crossover studies. CPAP was more effective at improving minimum arterial oxygen saturation during sleep compared with OA. In two small crossover studies, participants preferred OA therapy to CPAP. OA versus corrective upper airway surgery (one study): Symptoms of daytime sleepiness were initially lower with surgery, but this difference disappeared at 12 months. AHI did not differ significantly initially, but did so after 12 months in favour of OA. Authors' conclusions There is increasing evidence suggesting that OA improves subjective sleepiness and sleep disordered breathing compared with a control. CPAP appears to be more effective in improving sleep disordered breathing than OA. The difference in symptomatic response between these two treatments is not significant, although it is not possible to exclude an effect in favour of either therapy. Until there is more definitive evidence on the effectiveness of OA in relation to CPAP, with regard to symptoms and long‐term complications, it would appear to be appropriate to recommend OA therapy to patients with mild symptomatic OSAH, and those patients who are unwilling or unable to tolerate CPAP therapy. Future research should recruit patients with more severe symptoms of sleepiness, to establish whether the response to therapy differs between subgroups in terms of quality of life, symptoms and persistence with usage. Long‐term data on cardiovascular health are required.Keywords
This publication has 65 references indexed in Scilit:
- Effects of oral appliances and CPAP on the left ventricle and natriuretic peptidesInternational Journal of Cardiology, 2008
- Effects of a Mandibular Repositioning Appliance on Sleep Structure, Morning Behavior and Clinical Symptomatology in Patients with Snoring and Sleep-Disordered BreathingNeuropsychobiology, 2007
- Sexual Function and Obstructive Sleep Apnea–Hypopnea: A Randomized Clinical Trial Evaluating the Effects of Oral-Appliance and Continuous Positive Airway Pressure TherapyThe Journal of Sexual Medicine, 2007
- Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoeaThorax, 2007
- A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective studyEuropean Journal of Orthodontics, 2005
- Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized studyAmerican Journal of Orthodontics and Dentofacial Orthopedics, 2003
- Lifestyle modification for obstructive sleep apnoeaEmergencias, 2001
- Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS)American Journal of Orthodontics and Dentofacial Orthopedics, 1997
- The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apneaAmerican Journal of Orthodontics and Dentofacial Orthopedics, 1996
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996