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Evaluation of Anterior Mandibular Positioning Appliances for Treatment of Obstructive Sleep Apnea.


Center for Sleep and Chronobiology, University of Toronto.

Dental appliances are presently the only non-invasive alternative approach for treatment of sleep apnea. Although this treatment modality is not new, it has been somewhat neglected, mainly because of the uncertainties regarding efficacy, acceptance by patients, and dramatic success afforded by treatment with continuous positive airway pressure (CPAP) devices. However, there are many patients with sleep apnea who for various reasons cannot use CPAP. The purpose of this invell patients with sleep apnea or upper airway resistance syndrome presenting to our sleep disorders center. There were 23 patients (22 males and 1 female) who accepted to be fitted for the appliance and subsequently used it at home. All patients had standard nocturnal polysomnography. They were assessed by one dentist (JP) who constructed the TAP appliance for them. They started using it at home, and if there was any discomfort or continued snoring, the appliance was adjusted accordingly, until the patients were able to tolerate it. Prior to treatment patients’ bedpartner was asked to fill out a questionnaire dealing with their bedmates snoring. After the appliance was used at home for several weeks, the bedpartner once again filled out the same questionnaire. At the same time the patients filled out a questionnaire dealing with 1) overall comfort of the appliance, 2) possible side affects involving the jaw, teeth, tongue, and gums, and 3)excessive salivation. Nocturnal polysomnography was repeated with the appliance in place throughout the night. The results were analyzed by comparing the apnea/hypopnea indices without and with the appliance using paired t-test, comparing replies of the bedpartners regarding snoring before and with the appliance using chi-square test, and tabulating the replies of the patients dealing with the comfort of the appliance.

Patients ranged in age from 25 to 72 (mean SD = 47+ or – 12 yrs.). Their body mass index was 31 + or – 5 km/m2. We found that apnea/hypopnea index was reduced from 44 + or – 24 without the appliance to 14 + or – 9 with the appliance (p<0.005). bedpartners reported that without the appliance 83% of their bedmates snored either always or often, and 17% snored sometimes. with the appliance, 80% either did not snore or snored only rarely, and 20% snored sometimes. 71% of all patients were very satisfied with the appliance, and 21% were moderately satisfied. teeth discomfort was reported often by 25%, and never, rarely, or sometimes by the remaining 75%. similarly, jaw discomfort was reported often by 25%, and rarely or sometimes by 75%. most patients (75%) reported no tongue discomfort at all, and only 13% reported frequent gum discomfort.

We are encouraged by the subjective and objective efficacy of the appliance, its relatively high acceptance rate, and relatively low incidence of side affects. However, we must be cautious in recommending oral appliances as an initial treatment of sleep apnea in all patients, pending proper evaluation (i.e. efficacy and acceptability) of this appliance in a large group of patients with different severity of sleep apnea.