Role of Oral Appliances in the Treatment of Snoring and Sleep Apnea

sleep apnea oral appliances


Sleep disordered breathing is a result of repetitive airway obstruction and resultant oxy-hemoglobin de-saturation in deeper stages of sleep. It is thought that the condition is a result of both abnormal anatomy of the upper airway and some aberrant afferent/efferent somato- sensory loop. It is a highly prevalent condition affecting mainly the adult population and requiring cost effective management. Continuous positive airway pressure (CPAP) is an effective treatment for the condition but many patients cannot tolerate it. Anatomical reconstruction of the upper airway does not appeal to many patients. Use of oral appliances is the most effective and low cost treatment for treating snoring and sleep apnea. Oral appliances hold the airway in the back of the throat during sleep and prevent the airway from collapsing. They can be in the form of tongue retaining devices or mandibular repositioning devices.
A study was carried out by Wolfgang Schmidt- Nowara et al to describe quantified changes in sleep and snoring measures in subjects sleeping for the first time with an oral appliance of the jaw advancing type. The study analyzes the results of 21 publications which described 3210 patients treated with oral appliances for snoring and obstructive sleep apnea. Measures on the device night were compared to a baseline night, and a night spent sleeping with a placebo device.  Baseline levels of snoring, sleep, and sleep related breathing were initially determined.   In addition to standard all night polysomnography and oximetry, snoring sounds were detected, then amplified and displayed on a polygraph channel.   After baseline recording, the subjects were randomly given an oral appliance or a placebo which did not repositioned the mandible. The sleep pattern was recorded as the participants slept.
The results demonstrated that the oral appliances are very effective initially in reducing the snoring amount and intensity. 
    Tuesday, July 6, 2010