From the Guidelines
Treatment for snoring and sleep apnea should prioritize the use of mandibular advancement devices (MAD) for patients with mild to moderate OSA, as they have been shown to decrease the frequency and/or duration of apneas, hypopneas, and snoring events, while also improving nocturnal oxygenation and quality of life measures 1.
Key Considerations
- The most effective oral appliances (OAs) for treating OSA are MADs, which stabilize the lower jaw in a forward and downward position to maintain airway patency during sleep.
- MADs are indicated for patients with mild to moderate OSA, with no comorbidities and primary snoring, and are accepted as an alternative therapy for patients with severe OSA who do not respond to or are unable or unwilling to tolerate positive airway pressure (PAP) therapies.
- Contraindications for MADs include severe periodontal disease, severe pre-existing temporomandibular disorders (TMD), lack of adequate retention, and severe gag reflex.
Treatment Options
- Continuous positive airway pressure (CPAP) is considered the gold standard therapy for moderate to severe OSA syndrome, but other options like oral appliance therapy (OAT) with intraoral devices and surgery are available depending on the case severity, patient compliance, and other factors subject to medical evaluation.
- Myofunctional therapy (MT) and correct tongue positioning in the oral cavity have been described to improve mandibular growth, nasal breathing, and facial appearance, and may be explored as additional treatment options.
Importance of Collaboration
- The role of qualified dentists as an essential member of the multidisciplinary team in screening, treating, and managing patients with sleep breathing disorders (SBD) is emphasized, highlighting the need for collaboration between professionals and interdisciplinary approaches 1.
- Bidirectional referral patterns between dentists and physicians are recommended to ensure comprehensive care for patients with SBD.
From the Research
Treatment Options for Snoring and Sleep Apnea
- Lifestyle modification, intra-oral devices, or surgical intervention can be used to manage snoring 2
- Continuous positive airway pressure (CPAP) is the treatment of choice for moderate-to-severe obstructive sleep apnea 2, 3
- Oral appliances, such as mandibular advancement devices (MADs), can be a reasonable first-line treatment for mild to moderate obstructive sleep apnea syndrome (OSAS) 3, 4, 5
- Weight loss is recommended for patients with obstructive sleep apnea who are overweight or obese, as it may result in improvement in OSA 3, 6
- Upper airway surgical intervention, such as maxillomandibular advancement (MMA), can be considered as a second- or third-line treatment for moderate to severe OSA 3
- Pharmacotherapy has not been shown to be significantly effective in the treatment of OSA, but may be considered as an adjunctive treatment class 3, 6
Comparison of Treatment Options
- CPAP is more effective in lowering the apnea-hypopnea index (AHI) and shows higher oxyhemoglobin saturation levels compared to oral appliance therapy 4
- Oral appliance therapy can be considered as a viable treatment alternative to CPAP in patients with mild to moderate OSAS 4, 5
- CPAP remains the treatment of first choice for patients with severe OSAS 4
Diagnosis and Management
- Diagnosis of obstructive sleep apnea involves thorough clinical assessment and typically a sleep study 2, 6
- Home sleep apnea testing can be used to diagnose OSA, with a sensitivity of approximately 80% 6
- Effective treatments for OSA include weight loss and exercise, positive airway pressure, oral appliances, and surgical modification of the pharyngeal soft tissues or facial skeleton 6