Sleep Apnea and Oral Appliance Therapy (OAT)
Obstructive Sleep Apnea Syndrome (OSA) is a common sleep-disturbed breathing disorder where soft tissue of the throat repeatedly collapses during sleep, reducing the flow of air from entering the lungs. Loud snoring is a common feature of OSA and usually results in fragmenting the normal cycle of sleep. This hampering of breathing can also result in significantly lower blood oxygen levels.
Long term consequences of OSA may include excessive daytime sleepiness, diminished quality of life, impaired driving, hypertension, ischemic heart disease, congestive heart failure, and stroke.
Management of OSA includes Continuous Positive Airway Pressure (CPAP), Surgery, and Oral Appliance Therapy (OAT). Research has shown that none of these treatment modalities is effective in all OSA cases. For instance, even though CPAP has been shown to be very efficacious in managing OSA, patient compliance can be low (Barnes MR, et al., Vanderveken OM, et al., Phillips CL, et al., Gagnadoux F, et al.).
Research has shown that maxillofacial surgery is effective in treating certain OSA cases (Caples SM, et al., Zaghi et al.). However, the cost, possible side effects, and healing time are detractors in wide- spread public acceptance. Nasal surgeries may improve snoring, daytime sleepiness, quality of life and enhance CPAP and OAT effectiveness but do not improve objective indicators of OSA (Meen EK and Chandra RK).
Oral appliance therapy involves stabilizing the lower jaw bone in a forward position to prohibit narrowing and collapse of the upper airway. Mandibular advancement devices have good research to support the use in managing mild to moderate OSA. Patients tend to comply better with OAT than with CPAP (Barnes MR, et al., Vanderveken OM, et al., Phillips CL, et al., Gagnadoux F, et al.).
OAT improves nocturnal blood oxygen levels and lowers nocturnal diastolic blood pressure (Barnes MR, et al.). OAT improves daytime sleepiness, quality of life measurement, and driving simulator performance (Phillips CL, et al.) OAT is an effective therapy for reducing airway collapse in patients with mild to severe OSA (Gagnadoux F, et al.). Some disadvantages of long-term OAT may be excessive salivation, transient jaw joint and tooth pain and permanent bite changes. Even though side effects exist with OAT, it is recommended that:
Patients are prescribed OAT rather than no treatment for adults without OSA who request treatment of primary snoring (Ramar K, et al.)
Oral appliances are considered for patients that are intolerant to CPAP (Ramar K, et al.)
Dr. Greg Gullo is a Diplomate of the American Board of Dental Sleep Medicine (ABDSM) and a member of the American Academy of Dental Sleep Medicine (AADSM), the only non-profit professional association dedicated exclusively to the practice of dental sleep medicine. Dr. Greg helps treat snoring and obstructive sleep apnea with oral appliance therapy, an effective treatment that is covered by most insurance plans. AADSM membership provides Dr. Greg with access to educational resources and practice management tools that help him better serve his patients by providing the highest quality of care in the treatment of snoring and obstructive sleep apnea.
For more information about AADSM, visit www.aadsm.org.