From the Guidelines
Mandibular advancement devices are the most effective alternative treatment for sleep apnea besides CPAP therapy, particularly for mild to moderate cases. According to the most recent and highest quality study 1, mandibular advancement devices (MADs) have been shown to decrease the frequency and/or duration of apneas, hypopneas, respiratory effort-related arousals (RERA), and/or snoring events, as well as improve nocturnal oxygenation. They also reduce daytime sleepiness and improve quality of life measures in OSA, with a better adherence compared to CPAP.
Alternative Treatments for Sleep Apnea
Other alternative treatments for sleep apnea include:
- Positional therapy: involves using devices like special pillows or position trainers to prevent sleeping on your back, which can worsen apnea
- Weight loss: recommended for overweight patients as excess tissue can contribute to airway obstruction
- Surgical procedures: such as uvulopalatopharyngoplasty (UPPP) to remove excess tissue in the throat, maxillomandibular advancement to reposition the jaw, hypoglossal nerve stimulation using an implanted device, or nasal surgeries to address structural issues
- Lifestyle modifications: avoiding alcohol and sedatives before bedtime, establishing regular sleep schedules, and treating nasal congestion with saline sprays or antihistamines
Evidence-Based Recommendations
The American College of Physicians recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight 1. Additionally, mandibular advancement devices are recommended as an alternative therapy to continuous positive airway pressure treatment for patients diagnosed with OSA who prefer mandibular advancement devices or for those with adverse effects associated with continuous positive airway pressure treatment 1.
Key Considerations
When considering alternative treatments for sleep apnea, it is essential to evaluate the severity of the condition, patient preference, and specific anatomical factors contributing to the condition. A comprehensive approach that incorporates lifestyle modifications, oral appliances, and surgical procedures can help improve sleep apnea symptoms and overall quality of life.
From the Research
Alternative Treatments for Sleep Apnea
Alternative treatments for sleep apnea besides Continuous Positive Airway Pressure (CPAP) therapy include:
- Oral appliance therapy, which is the leading alternative to CPAP for obstructive sleep apnea (OSA) 2, 3, 4, 5
- Mandibular advancement devices (MADs), which are a type of oral appliance that advances the mandible to increase airway diameter and reduce collapsibility 5, 6
Oral Appliance Therapy
Oral appliance therapy has been shown to be effective in reducing the apnea-hypopnea index (AHI) and improving sleep quality 3, 4. It is also well tolerated and has been associated with higher patient adherence compared to CPAP therapy 2, 5. However, the effectiveness of oral appliance therapy can vary, and reliable prediction tools for patients who respond best to this therapy are still needed 5.
Mandibular Advancement Devices
Mandibular advancement devices (MADs) are a type of oral appliance that have been shown to be effective in reducing the AHI and improving sleep quality 5, 6. They work by advancing the mandible to increase airway diameter and reduce collapsibility. MADs are generally well tolerated, but may have side effects such as temporomandibular joint (TMJ) dysfunction, hypersalivation, tooth pain, and occlusal changes 5.
Comparison to CPAP Therapy
While CPAP therapy is still considered the gold standard treatment for OSA, oral appliance therapy and MADs have been shown to be effective alternatives for patients who are intolerant to CPAP or have mild to moderate OSA 3, 4, 6. In fact, a 2-year follow-up study found that oral appliance therapy was equivalent to CPAP therapy in terms of subjective and objective treatment outcomes for patients with mild to severe OSA 4. However, CPAP therapy remains the most effective treatment for reducing the AHI, and oral appliance therapy and MADs may not be as effective for patients with severe OSA 4, 6.