Dental Management of Snoring and Obstructive Sleep Apnea
The first line of therapy in the management of Snoring and Obstructive Sleep Apnea (OSA) is to establish healthy “Lifestyle Choices” and “Sleep Hygiene”. Lifestyle choices that influence Snoring and OSA are; weight, fitness, alcohol, smoking and medication. Sleep hygiene refers to the sleep environment including factors such as ambient noise and light levels. However, when Snoring or OSA persists, the most commonly prescribed therapy is nasal continuous positive airway pressure (nCPAP). Although nCPAP is very effective, usually resolving the symptoms completely, many find it difficult to tolerate; approximately 1/3rd of patients either do not comply or refuse to use it at all. Surgical procedures of various kinds are also available, each with varying success rates; basically, the more radical the surgery the higher the success rate.
Another therapeutic approach for the treatment of snoring and obstructive sleep apnea, Airway Orthotic Therapy (AOT) works by advancing the jaw, which creates tension in the airway soft tissues, advances the base of the tongue out of the airway and actually causes the upper airway to increase in size and stiffen. In short, an Airway Orthotic makes the airway larger and stiffer so it does not collapse as easily.
AOT effectively manages “moderate sleep apnea” 80% of the time, and “severe sleep apnea” 61% of the time1, “Snoring is improved in almost all patients and is often eliminated”.2 It is “ indicated for use in patients with primary snoring or mild to moderate OSA who do not respond to or are not appropriate candidates for treatment with behavioral measures such as weight loss or sleep position change” 2,3 and for “ patients with severe OSA who are intolerant or refuse treatment with nCPAP” 2,3. Therefore OAT should be considered when treating snoring and obstructive sleep apnea.
AOT is conservative and completely reversible. Side effects are usually short lived and are rarely a problem. Some patients experience changes in tooth position; mostly minor in nature. Long-term compliance for AOT has been demonstrated to be 90% after 2 1/2 years 4.
Studies comparing AOT and nCPAP demonstrate that AOT is effective in treating snoring and mild to moderately severe OSA, and is preferred by 10 out of 11 patients as a long-term treatment 5.
Lower cost temporary Orthotics are available, but they are not as comfortable, durable or adjustable as one that has been custom fabricated. Consequently, they have a lower success rate and may leave one with the erroneous feeling that it does not work.
When deciding between the various custom fabricated Airway Orthotics, keep in mind that any Orthotic that manipulates the mandible to the same degree can be expected to produce an equivalent improvement in symptoms. The issue then becomes one of cost, comfort and durability 5,6,7. However, the more adjustable an Airway Orthotic is the higher the likelihood of a good outcome.
John Viviano BSc, DDS Diplomate ABDSM- Practices sleep dentistry in Mississauga ON Canada- firstname.lastname@example.org
1) Lowe et al. Sleep. 2000; 23: 172-178
2) AASM Sleep 2006; Vol. 29, No. 2
3) CTS: Can Respir J 2006; Vol. 13, No. 7
4) Yoshida et al. Cranio: 2000:18:2.
5) Clark et al. Chest 1996; 109:1477-1483
6) Ferguson et al. Thorax 1997; 52:362-368
7) Fleetham et al. Am J Respir Crit Care
Med 1997; 155 (part 2 of 2 parts):A939