Saturday, February 11, 2006

Oral Appliances for Sleep Apnea

The National Sleep Foundation reports on the new American Academy of Sleep Medicine Practice Parameter for the use of oral appliances for the treatment of obstructive sleep apnea:
An oral appliance for sleep disordered breathing is a device that a dentist fits on the teeth or mouth to reduce snoring and to treat sleep apnea. Given how creative dentists are hundreds of such devices have been developed. Now the American Academy of Sleep Medicine (AASM) has updated its practice parameter recommendations for use of such devices. AASM’s experts find that the devices can be effective to treat snoring and mild to moderate sleep apnea, but they also caution that there is much more evidence – and better evidence – that continuous positive air pressure (CPAP) should be the first form of therapy for obstructive sleep apnea. They also caution that patients fitted with oral devices should be thoroughly evaluated before and after a device is fitted to determine whether it is not only reducing snoring and improving sleep as perceived by the patient, but also maintaining blood oxygen at the appropriate levels. But according to one practitioner of dental sleep medicine, it is very important to find a specialist who is familiar with the many available types of devices. He said that too many dentists fitting patients with oral appliances are familiar with only one type and this is an area where "one type does not fit all."
The major changes compared to the old 1995 practice parameters are:
1) a follow-up sleep study to ensure resolution of OSA is now recommended even for mild cases of OSA
and
2) the new parameters specify that dentists should be fitting these devices. There are some oral appliances out there that can be fitted by physicians without dental training. I was planning on using one of these in my sleep practice, but will now reconsider this.

6 comments:

Pepper said...

As a dentist who has placed over 1000 appliances for OSA in conjunction with sleep centers in my area, I suggest you find a dentist to work with. The fine points we have found are numerous. Neuromuscular effects, adaptive jaw positioning, and changes as small as .17mm have produced noted result difference on a PSG. You will find even severe cases improve trememdously. You will also note a few failures. Just finished a clinical study showing 88% successful cases. It is our goal to be able to predict the successful cases prior to therapy with Oral Appliances. There seems to be 5 main factors that show a linear agreement to successful cases. If so, I believe you will find that OAT will be first line therapy in the years to come as was suggested in the American Journal of Respiratory and Critical Care 2001 editorial.

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