Abstract
Oral appliances are increasingly gaining a place in the treatment of sleep disordered breathing caused by upper airway obstruction. This review of publications since 1995 documents substantial progress in the scientific basis for this therapy. Imaging by several techniques has shown that mandibular advancing oral appliances open the airway in awake and anaesthetized subjects, creating the presumption that this effect is maintained in sleep. Three controlled cross-over treatment trials have shown that patients consistently prefer oral appliance over continuous positive airway pressure therapy, especially when the treatment effect is strong. Appliance design and use indicates a preference for adjustable mandibular advancing appliances. Complications of therapy appear to be infrequent, but evidence for safety of long-term use is still limited. Oral appliance therapy can be an effective therapy for sleep disorders caused by upper airway obstruction. Considering the accumulated evidence, it is no longer tenable to label oral appliance therapy an ⊚experimentalÕ procedure.
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Meier-Ewert K, Schafer H, Kloss W. Treatment of sleep apnea by a mandibular protracting device. Berichtsband 7th European Congress on Sleep Research, Munich, Germany, 1984; p 217
Kloss W, Meier-Ewert K, Schaefer H. Zur Therapie des obstruktiven Schlaf-Apnoe-Syndroms. Fortschritte der Neurologie und Psychiatrie 1986;54:267–271
Cartwright R, Samelson C. The effects of a nonsurgical treatment for obstructive sleep apnea. JAMA 1982;248:705–709
Soll B, George P. Treatment of obstructive sleep apnea with a nocturnal airway-patency appliance. N Engl J Med 1985;313:386–387
Schmidt-Nowara W, Lowe A, Wiegand L, et al. Oral appliances for the treatment of snoring and obstructive sleep apnea: A review. Sleep 1995;18:501–510
American Sleep Disorders Association Standards of Practice Committee. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 1995;18:511–513
Mayer G, Meier-Ewert K. Cephalometric predictors for orthopaedic mandibular advancement in obstructive sleep apnoea. Eur J Orthod 1995;17:35–43
Lowe AA, Ono T, Ferguson KA, et al. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofac Orthop 1996;110:653–664
Schmidt-Nowara WW, Williamson MS, Olivera DL, Meade TE. The effect of a dental appliance for snoring on upper airway anatomy. Am Rev Resp Dis 1993;147:682A
Isono S, Tanaka A, Sho Y, Konno A, Nishino T. Advancement of the mandible improves velopharyngeal patency. J Appl Physiol 1995;79:2132–2138
Ferguson KA, Love LI, Ryan CF. Effect of mandibular and tongue protrusion on upper airway size during wakefulness. Am Rev Respir Dis 1997;155:1748–1754
Ferguson KA, Ono T, Lowe AA, et al. A short term controlled trial of an adjustable oral appliance for the treatment of mildmoderate obstructive sleep apnea. Thorax 1997;52:362–368
Lowe A, Fleetham J, Ryan F, Matthews B. Effects of mandibular repositioning appliance used in the treatment of obstructive sleep apnea on tongue muscle activity. In: Suratt PM, Remmers JE, eds. Sleep and Respiration. New York: Wiley-Liss, 1990:395–405
Miyamoto K, Ozbek M, Lowe A, et al. Mandibular posture during sleep in healthy adults. Arch Oral Biol. 1998;43:269–275
Miyamoto K, Ozbek M, Lowe A, et al. Vertical mandibular posture during sleep in patients with obstructive sleep apnea. Thorax. Arch Oral Biol 1999;44:657–664
Marklund M, Franklin KA, Sahlin C, Ludgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998;113:707–713
Lowe AA, Sjöholm TT, Ryan CF, et al. Treatment, airway and compliance effects of a titratable oral appliance. Sleep (in press)
Menn SJ, Loube DI, Morgan TD, et al. The mandibular repositioning device: Role in the treatment of obstructive sleep apnea. Sleep 1996;19:794–800
Millman R, Rosenberg C, Carlisle C, et al. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty. Chest 1998;113:992–996
Loube DI, Andrada T, Shanmagum N, Singer M. Successful treatment of upper airway resistance syndrome with an oral appliance. Accepted, Sleep and Breathing, October, 1997
American Academy of Sleep Medicine Task Force. Sleep related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22:664–686
Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasalcontinuous positive airway pressure in the treatment of mildmoderate obstructive sleep apnea. Chest 1996;109:1269–1275
Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A cross-over study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest 1996;109:1477–1483
Engleman H, Kingshott R, Wraith P, et al. Randomized placebocontrolled crossover trial of continuous positive airway pressure for mild sleep apnoea/hypopnea syndrome. Am J Respir Crit Care Med 1999;159:461–467
Jenkinson C, Davies R, Mullins R, Stradling J. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: A randomized prospective parallel trial. Lancet 1999;353:2100–2105
Polo O. Continuous positive airway treatment for obstructive sleep apnoea. Lancet 1999;353;2086–2087
Rauscher H, Formanek D, Zwick H. Nasal continuous positive airway pressure for nonapneic snoring. Chest 1995;107:58–61
Schmidt-Nowara W. Alternatives to CPAP treatment of OSA and decision making pathways. Sleep; in press
Petitjean T, Bruno M, Langevin B, Philit F, Robert D. Relative efficacy of mandibular advancement device is independent of the initial severity. Am J Respir Crit Care Med 1999;159:A249
Rogers R, Lowe A. Oral appliances for the management of snoring and obstructive sleep apnea - A comprehensive guide for the sleep disorder dentist. Slide/Tape sequence for the Sleep Disorders Dental Society; 1997
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Schmidt-Nowara, W. Recent Developments in Oral Appliance Therapy of Sleep Disordered Breathing. Sleep Breath 3, 103–106 (1999). https://doi.org/10.1007/s11325-999-0103-7
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DOI: https://doi.org/10.1007/s11325-999-0103-7