Skip to main content
SpringerLink
Log in

Oral Appliance Therapy

  • Chapter
  • First Online:
Management of Obstructive Sleep Apnea

Abstract

Oral appliances (OAs) aim to increase the upper airway size, facilitate breathing during the night, and reduce obstructive sleep apnea (OSA) and snoring (◘ Fig. 13.1a, b). There are two subgroups of OAs: the mandibular advancement device (OAM) (◘ Fig. 13.2) and the tongue-retaining device (OAT) (◘ Fig. 13.3). OAM is attached to the teeth and holds the mandible forward during sleep. This treatment has the highest level of evidence among non-PAP therapies [1–4]. OAT aims to hold the tongue forward into an anterior bulb by suction and can be used irrespective of the presence of teeth. Both devices reduce sleep apneas, but OAM is better tolerated and has been much more studied.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 69.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, et al. Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J. 2011;37(5):1000–28.

    Article  CAS  PubMed  Google Scholar 

  2. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med. 2015;11(7):773–827.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Med Rev. 2016;27:108–24.

    Article  PubMed  Google Scholar 

  4. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, et al. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014;10(2):215–27.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Edwards BA, Redline S, Sands SA, Owens RL. More than the sum of the respiratory events: personalized medicine approaches for obstructive sleep apnea. Am J Respir Crit Care Med. 2019;200(6):691–703.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep. 1995;18(6):501–10.

    Article  CAS  PubMed  Google Scholar 

  7. Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, et al. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest. 2000;117(4):1065–72.

    Article  CAS  PubMed  Google Scholar 

  8. Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax. 2010;65(8):726–32.

    Article  PubMed  Google Scholar 

  9. Zhao Y, Shi H, Lu X, Chen J, Nie P, Tang Y, et al. Oral appliance effectively reverses Muller’s maneuver-induced upper airway collapsibility in obstructive sleep apnea and hypopnea syndrome. Sleep Breath. 2015;19(1):213–20.

    Article  PubMed  Google Scholar 

  10. Bamagoos AA, Cistulli PA, Sutherland K, Ngiam J, Burke PGR, Bilston LE, et al. Dose-dependent effects of mandibular advancement on upper airway collapsibility and muscle function in obstructive sleep apnea. Sleep. 2019;42(6)

    Google Scholar 

  11. Gakwaya S, Melo-Silva CA, Borel JC, Rousseau E, Masse JF, Series F. Impact of stepwise mandibular advancement on upper airway mechanics in obstructive sleep apnea using phrenic nerve magnetic stimulation. Respir Physiol Neurobiol. 2014;190:131–6.

    Article  PubMed  Google Scholar 

  12. Sasao Y, Nohara K, Okuno K, Nakamura Y, Sakai T. Videoendoscopic diagnosis for predicting the response to oral appliance therapy in severe obstructive sleep apnea. Sleep Breath. 2014;18(4):809–15.

    Article  PubMed  Google Scholar 

  13. Edwards BA, Eckert DJ, Jordan AS. Obstructive sleep apnoea pathogenesis from mild to severe: is it all the same? Respirology. 2017;22(1):33–42.

    Article  PubMed  Google Scholar 

  14. Edwards BA, Andara C, Landry S, Sands SA, Joosten SA, Owens RL, et al. Upper-airway collapsibility and loop gain predict the response to oral appliance therapy in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2016;194(11):1413–22.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brown EC, Cheng S, McKenzie DK, Butler JE, Gandevia SC, Bilston LE. Tongue and lateral upper airway movement with mandibular advancement. Sleep. 2013;36(3):397–404.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dieltjens M, Vanderveken OM, Heyning PH, Braem MJ. Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Med Rev. 2012;16(2):177–85.

    Article  PubMed  Google Scholar 

  17. Dieltjens M, Vanderveken OM, Van den Bosch D, Wouters K, Denollet J, Verbraecken JA, et al. Impact of type D personality on adherence to oral appliance therapy for sleep-disordered breathing. Sleep Breath. 2013;17(3):985–91.

    Article  CAS  PubMed  Google Scholar 

  18. Lettieri CJ, Paolino N, Eliasson AH, Shah AA, Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med. 2011;7(5):439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sari E, Menillo S. Comparison of titratable oral appliance and mandibular advancement splint in the treatment of patients with obstructive sleep apnea. ISRN Dent. 2011;2011:581692.

    PubMed  PubMed Central  Google Scholar 

  20. Varendh M, Andersson M, Bjornsdottir E, Hrubos-Strom H, Johannisson A, Arnardottir ES, et al. Nocturnal nasal obstruction is frequent and reduces sleep quality in patients with obstructive sleep apnea. J Sleep Res. 2018;27(4):e12631.

    Article  PubMed  Google Scholar 

  21. Masse JF, Bellerive A, Sériès F, St-Pierre L. Prospective assessment of maximum protrusion in patients wearing a mandibularadvancement device. J Dent Sleep Med. 2018;5(1):11–16.

    Google Scholar 

  22. Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, et al. A feedback-controlled mandibular positioner identifies individuals with sleep apnea who will respond to oral appliance therapy. J Clin Sleep Med. 2017;13(7):871–80.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Brugarolas R, Valero-Sarmiento JM, Bozkurt A, Essick GK. Auto-adjusting mandibular repositioning device for in-home use. Conf Proc IEEE Eng Med Biol Soc. 2016;2016:4296–9.

    CAS  Google Scholar 

  24. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration. 2011;81(5):411–9.

    Article  PubMed  Google Scholar 

  25. Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004;170(6):656–64.

    Article  PubMed  Google Scholar 

  26. Blanco J, Zamarron C, Abeleira Pazos MT, Lamela C, Suarez QD. Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath. 2005;9(1):20–5.

    Article  CAS  PubMed  Google Scholar 

  27. Duran-Cantolla J, Crovetto-Martinez R, Alkhraisat MH, Crovetto M, Municio A, Kutz R, et al. Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: a randomized controlled crossover clinical trial. Med Oral Patol Oral Cir Bucal. 2015;20(5):e605–15.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gagnadoux F, Pepin JL, Vielle B, Bironneau V, Chouet-Girard F, Launois S, et al. Impact of mandibular advancement therapy on endothelial function in severe obstructive sleep apnea. Am J Respir Crit Care Med. 2017;195(9):1244–52.

    Article  PubMed  Google Scholar 

  29. Gotsopoulos H, Chen C, Qian J, Cistulli PA. Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Am J Respir Crit Care Med. 2002;166(5):743–8.

    Article  PubMed  Google Scholar 

  30. Hans MG, Nelson S, Luks VG, Lorkovich P, Baek SJ. Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS). Am J Orthod Dentofac Orthop. 1997;111(5):562–70.

    Article  CAS  Google Scholar 

  31. Johnston CD, Gleadhill IC, Cinnamond MJ, Gabbey J, Burden DJ. Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial. Eur J Orthod. 2002;24(3):251–62.

    Article  PubMed  Google Scholar 

  32. Lam B, Sam K, Mok WY, Cheung MT, Fong DY, Lam JC, et al. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax. 2007;62(4):354–9.

    Article  PubMed  Google Scholar 

  33. Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med. 2015;175(8):1278–85.

    Article  PubMed  Google Scholar 

  34. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163(6):1457–61.

    Article  CAS  PubMed  Google Scholar 

  35. Naismith SL, Winter VR, Hickie IB, Cistulli PA. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2005;1(4):374–80.

    Article  PubMed  Google Scholar 

  36. Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res. 2008;17(2):221–9.

    Article  PubMed  Google Scholar 

  37. Quinnell TG, Bennett M, Jordan J, Clutterbuck-James AL, Davies MG, Smith IE, et al. A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO). Thorax. 2014;69(10):938–45.

    Article  PubMed  Google Scholar 

  38. Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, et al. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med. 2002;166(6):855–9.

    Article  PubMed  Google Scholar 

  39. Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax. 1997;52(4):362–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996;109(5):1269–75.

    Article  CAS  PubMed  Google Scholar 

  41. Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, N'Guyen XL, et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34(4):914–20.

    Article  CAS  PubMed  Google Scholar 

  42. Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LG. Obstructive sleep apnea therapy. J Dent Res. 2008;87(9):882–7.

    Article  CAS  PubMed  Google Scholar 

  43. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187(8):879–87.

    Article  PubMed  Google Scholar 

  44. Randerath WJ, Heise M, Hinz R, Ruehle KH. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest. 2002;122(2):569–75.

    Article  PubMed  Google Scholar 

  45. Tan YK, L’Estrange PR, Luo YM, Smith C, Grant HR, Simonds AK, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod. 2002;24(3):239–49.

    Article  CAS  PubMed  Google Scholar 

  46. Holley AB, Lettieri CJ, Shah AA. Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest. 2011;140(6):1511–6.

    Article  PubMed  Google Scholar 

  47. Marklund M, Verbraecken J, Randerath W. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J. 2012;39(5):1241–7.

    Article  PubMed  Google Scholar 

  48. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig. 2010;14(3):339–45.

    Article  PubMed  Google Scholar 

  49. Anitua E, Duran-Cantolla J, Almeida GZ, Alkhraisat MH. Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea. Sleep Med. 2017;34:226–31.

    Article  PubMed  Google Scholar 

  50. Bartolucci ML, Bortolotti F, Raffaelli E, D'Anto V, Michelotti A, Alessandri BG. The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis. Sleep Breath. 2016;20(3):911–9.

    Article  PubMed  Google Scholar 

  51. Ma Y, Yu M, Gao X. The effect of gradually increased mandibular advancement on the efficacy of an oral appliance in the treatment of obstructive sleep apnea. J Clin Sleep Med. 2020;16(8):1369–76.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vroegop AV, Vanderveken OM, Van de Heyning PH, Braem MJ. Effects of vertical opening on pharyngeal dimensions in patients with obstructive sleep apnoea. Sleep Med. 2012;13(3):314–6.

    Article  PubMed  Google Scholar 

  53. Marklund M, Franklin KA, Stenlund H, Persson M. Mandibular morphology and the efficacy of a mandibular advancement device in patients with sleep apnoea. Eur J Oral Sci. 1998;106(5):914–21.

    Article  CAS  PubMed  Google Scholar 

  54. Pitsis AJ, Darendeliler MA, Gotsopoulos H, Petocz P, Cistulli PA. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med. 2002;166(6):860–4.

    Article  PubMed  Google Scholar 

  55. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompre PH, Lavigne GJ. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med. 2009;10(3):329–36.

    Article  PubMed  Google Scholar 

  56. Bishop B, Verrett R, Girvan T. A randomized crossover study comparing two mandibular repositioning appliances for treatment of obstructive sleep apnea. Sleep Breath. 2014;18(1):125–31.

    Article  PubMed  Google Scholar 

  57. Bloch KE, Iseli A, Zhang JN, Xie X, Kaplan V, Stoeckli PW, et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med. 2000;162(1):246–51.

    Article  CAS  PubMed  Google Scholar 

  58. Ghazal A, Sorichter S, Jonas I, Rose EC. A randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res. 2009;18(3):321–8.

    Article  PubMed  Google Scholar 

  59. Johal A, Haria P, Manek S, Joury E, Riha R. Ready-made versus custom-made mandibular repositioning devices in sleep apnea: a randomized clinical trial. J Clin Sleep Med. 2017;13(2):175–82.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Lawton HM, Battagel JM, Kotecha B. A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Orthod. 2005;27(1):82–90.

    Article  CAS  PubMed  Google Scholar 

  61. Norrhem N, Marklund M. An oral appliance with or without elastic bands to control mouth opening during sleep-a randomized pilot study. Sleep Breath. 2016;20(3):929–38.

    Article  PubMed  Google Scholar 

  62. Rose E, Staats R, Virchow C, Jonas IE. A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod. 2002;24(2):191–8.

    Article  PubMed  Google Scholar 

  63. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, et al. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med. 2008;178(2):197–202.

    Article  PubMed  Google Scholar 

  64. Zhou J, Liu YH. A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil. 2012;39(12):914–22.

    Article  CAS  PubMed  Google Scholar 

  65. Isacsson G, Nohlert E, Fransson AMC, Bornefalk-Hermansson A, Wiman Eriksson E, Ortlieb E, et al. Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial. Eur J Orthod. 2019;41(1):80–8.

    Article  PubMed  Google Scholar 

  66. Friedman M, Hamilton C, Samuelson CG, Kelley K, Pearson-Chauhan K, Taylor D, et al. Compliance and efficacy of titratable thermoplastic versus custom mandibular advancement devices. Otolaryngol Head Neck Surg. 2012;147(2):379–86.

    Article  PubMed  Google Scholar 

  67. Umemoto G, Toyoshima H, Yamaguchi Y, Aoyagi N, Yoshimura C, Funakoshi K. Therapeutic efficacy of twin-block and fixed oral appliances in patients with obstructive sleep apnea syndrome. J Prosthodont. 2019;28(2):e830–e6.

    Article  PubMed  Google Scholar 

  68. Milano F, Mutinelli S, Sutherland K, Milioli G, Scaramuzzino G, Siciliani G, et al. Influence of vertical mouth opening on oral appliance therapy outcome in positional obstructive sleep apnea. J Dent Sleep Med. 2018;5(1):17–23.

    Google Scholar 

  69. Gagnadoux F, Nguyen XL, Le Vaillant M, Priou P, Meslier N, Eberlein A, et al. Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea. Respir Med. 2017;131:35–42.

    Article  PubMed  Google Scholar 

  70. Braem M. In vitro retention of a new thermoplastic titratable mandibular advancement device. F1000Res. 2015;4:56.

    Article  PubMed  PubMed Central  Google Scholar 

  71. El Ibrahimi M, Laabouri M. Pilot study of a new adjustable thermoplastic mandibular advancement device for the management of obstructive sleep apnoea-hypopnoea syndrome: A Brief Research Letter. Open Respir Med J. 2016;10:46–50.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Suga H, Mishima K, Nakano H, Nakano A, Matsumura M, Mano T, et al. Different therapeutic mechanisms of rigid and semi-rigid mandibular repositioning devices in obstructive sleep apnea syndrome. J Craniomaxillofac Surg. 2014;42(8):1650–4.

    Article  PubMed  Google Scholar 

  73. Kastoer C, Dieltjens M, Oorts E, Hamans E, Braem MJ, Van de Heyning PH, et al. The use of remotely controlled mandibular positioner as a predictive screening tool for mandibular advancement device therapy in patients with obstructive sleep apnea through single-night progressive titration of the mandible: a systematic review. J Clin Sleep Med. 2016;12(10):1411–21.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Remmers J, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, et al. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Sleep. 2013;36(10):1517–25, 25A.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Sutherland K, Ngiam J, Cistulli PA. Performance of remotely controlled mandibular protrusion sleep studies for prediction of oral appliance treatment response. J Clin Sleep Med. 2017;13(3):411–7.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Okuno K, Pliska BT, Hamoda M, Lowe AA, Almeida FR. Prediction of oral appliance treatment outcomes in obstructive sleep apnea: a systematic review. Sleep Med Rev. 2016;30:25–33.

    Article  PubMed  Google Scholar 

  77. Vroegop AV, Vanderveken OM, Dieltjens M, Wouters K, Saldien V, Braem MJ, et al. Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res. 2013;22(3):348–55.

    Article  PubMed  Google Scholar 

  78. De Corso E, Bastanza G, Della Marca G, Grippaudo C, Rizzotto G, Marchese MR, et al. Drug-induced sleep endoscopy as a selection tool for mandibular advancement therapy by oral device in patients with mild to moderate obstructive sleep apnoea. Acta Otorhinolaryngol Ital. 2015;35(6):426–32.

    PubMed  Google Scholar 

  79. Okuno K, Sasao Y, Nohara K, Sakai T, Pliska BT, Lowe AA, et al. Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea. Eur Respir J. 2016;47(5):1410–9.

    Article  PubMed  Google Scholar 

  80. Sutherland K, Chan ASL, Ngiam J, Darendeliler MA, Cistulli PA. Qualitative assessment of awake nasopharyngoscopy for prediction of oral appliance treatment response in obstructive sleep apnoea. Sleep Breath. 2018;22(4):1029–36.

    Article  PubMed  Google Scholar 

  81. Genta PR, Sands SA, Butler JP, Loring SH, Katz ES, Demko BG, et al. Airflow shape is associated with the pharyngeal structure causing OSA. Chest. 2017;152(3):537–46.

    Article  PubMed  PubMed Central  Google Scholar 

  82. de Chazal P, Sutherland K, Cistulli PA. Advanced polysomnographic analysis for OSA: A pathway to personalized management? Respirology. 2020;25(3):251–8.

    Article  PubMed  Google Scholar 

  83. Bosshard V, Masse JF, Series F. Prediction of oral appliance efficiency in patients with apnoea using phrenic nerve stimulation while awake. Thorax. 2011;66(3):220–5.

    Article  PubMed  Google Scholar 

  84. Ng AT, Qian J, Cistulli PA. Oropharyngeal collapse predicts treatment response with oral appliance therapy in obstructive sleep apnea. Sleep. 2006;29(5):666–71.

    PubMed  Google Scholar 

  85. Sanner BM, Heise M, Knoben B, Machnick M, Laufer U, Kikuth R, et al. MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome. Eur Respir J. 2002;20(1):143–50.

    Article  CAS  PubMed  Google Scholar 

  86. Kent DT, Rogers R, Soose RJ. Drug-induced sedation endoscopy in the evaluation of OSA patients with incomplete oral appliance therapy response. Otolaryngol Head Neck Surg. 2015;153(2):302–7.

    Article  PubMed  Google Scholar 

  87. Vena D, Azarbarzin A, Marques M, Op de Beeck S, Vanderveken OM, Edwards BA, et al. Predicting sleep apnea responses to oral appliance therapy using polysomnographic airflow. Sleep. 2020;43(7)

    Google Scholar 

  88. Bamagoos AA, Cistulli PA, Sutherland K, Madronio M, Eckert DJ, Hess L, et al. Polysomnographic endotyping to select patients with obstructive sleep apnea for oral appliances. Ann Am Thorac Soc. 2019;16(11):1422–31.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Stoberl AS, Schwarz EI, Haile SR, Turnbull CD, Rossi VA, Stradling JR, et al. Night-to-night variability of obstructive sleep apnea. J Sleep Res. 2017;26(6):782–8.

    Article  PubMed  Google Scholar 

  90. McNicholas WT. Obstructive sleep apnoea of mild severity: should it be treated? Curr Opin Pulm Med. 2017;23(6):506–11.

    Article  PubMed  Google Scholar 

  91. Prasad B, Usmani S, Steffen AD, Van Dongen HP, Pack FM, Strakovsky I, et al. Short-term variability in apnea-hypopnea index during extended home portable monitoring. J Clin Sleep Med. 2016;12(6):855–63.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Gjerde K, Lehmann S, Berge ME, Johansson AK, Johansson A. Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to CPAP. J Oral Rehabil. 2016;43(4):249–58.

    Article  CAS  PubMed  Google Scholar 

  93. Lee CH, Kim DK, Kim SY, Rhee CS, Won TB. Changes in site of obstruction in obstructive sleep apnea patients according to sleep position: a DISE study. Laryngoscope. 2015;125(1):248–54.

    Article  PubMed  Google Scholar 

  94. Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97(4):780–5.

    Article  PubMed  Google Scholar 

  95. Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev. 2014;18(1):7–17.

    Article  PubMed  Google Scholar 

  96. Pevernagie DA, Stanson AW, Sheedy PF 2nd, Daniels BK, Shepard JW Jr. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;152(1):179–85.

    Article  CAS  PubMed  Google Scholar 

  97. Marques M, Genta PR, Sands SA, Azarbazin A, de Melo C, Taranto-Montemurro L, et al. Effect of sleeping position on upper airway patency in obstructive sleep apnea is determined by the pharyngeal structure causing collapse. Sleep. 2017;40(3):zsx005.

    Article  PubMed Central  Google Scholar 

  98. Frank MH, Ravesloot MJ, van Maanen JP, Verhagen E, de Lange J, de Vries N. Positional OSA part 1: towards a clinical classification system for position-dependent obstructive sleep apnoea. Sleep Breath. 2015;19(2):473–80.

    Article  CAS  PubMed  Google Scholar 

  99. Dieltjens M, Braem MJ, Van de Heyning PH, Wouters K, Vanderveken OM. Prevalence and clinical significance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy. J Clin Sleep Med. 2014;10(9):959–64.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(5):724–31.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest. 2004;125(4):1270–8.

    Article  PubMed  Google Scholar 

  102. Takaesu Y, Tsuiki S, Kobayashi M, Komada Y, Nakayama H, Inoue Y. Mandibular advancement device as a comparable treatment to nasal continuous positive airway pressure for positional obstructive sleep apnea. J Clin Sleep Med. 2016;12(8):1113–9.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Petri N, Christensen IJ, Svanholt P, Sonnesen L, Wildschiodtz G, Berg S. Mandibular advancement device therapy for obstructive sleep apnea: a prospective study on predictors of treatment success. Sleep Med. 2019;54:187–94.

    Article  PubMed  Google Scholar 

  104. Sutherland K, Takaya H, Qian J, Petocz P, Ng AT, Cistulli PA. Oral appliance treatment response and polysomnographic phenotypes of obstructive sleep apnea. J Clin Sleep Med. 2015;11(8):861–8.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Kairaitis K, Stavrinou R, Parikh R, Wheatley JR, Amis TC. Mandibular advancement decreases pressures in the tissues surrounding the upper airway in rabbits. J Appl Physiol. 1985;100(1):349–56.

    Article  Google Scholar 

  106. Vecchierini MF, Attali V, Collet JM, d'Ortho MP, Goutorbe F, Kerbrat JB, et al. Sex differences in mandibular repositioning device therapy effectiveness in patients with obstructive sleep apnea syndrome. Sleep Breath. 2019;23(3):837–48.

    Article  PubMed  Google Scholar 

  107. Chen H, Eckert DJ, van der Stelt PF, Guo J, Ge S, Emami E, et al. Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Med Rev. 2020;49:101229.

    Article  PubMed  Google Scholar 

  108. Heinzer R, Vat S, Marques-Vidal P, Marti-Soler H, Andries D, Tobback N, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  109. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev. 2017;34:70–81.

    Article  PubMed  Google Scholar 

  110. Tsuiki S, Ito E, Isono S, Ryan CF, Komada Y, Matsuura M, et al. Oropharyngeal crowding and obesity as predictors of oral appliance treatment response to moderate obstructive sleep apnea. Chest. 2013;144(2):558–63.

    Article  PubMed  Google Scholar 

  111. Kulkas A, Leppanen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, et al. Amount of weight loss or gain influences the severity of respiratory events in sleep apnea. Med Biol Eng Comput. 2015;53(10):975–88.

    Article  CAS  PubMed  Google Scholar 

  112. Denolf PL, Vanderveken OM, Marklund ME, Braem MJ. The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients. Sleep Med Rev. 2016;27:56–73.

    Article  PubMed  Google Scholar 

  113. Marklund M, Franklin KA. Treatment of elderly patients with snoring and obstructive sleep apnea using a mandibular advancement device. Sleep Breath. 2015;19(1):403–5.

    Article  PubMed  Google Scholar 

  114. Carballo NJ, Alessi CA, Martin JL, Mitchell MN, Hays RD, Col N, et al. Perceived effectiveness, self-efficacy, and social support for oral appliance therapy among older veterans with obstructive sleep apnea. Clin Ther. 2016;38(11):2407–15.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Sutherland K, Phillips CL, Davies A, Srinivasan VK, Dalci O, Yee BJ, et al. CPAP pressure for prediction of oral appliance treatment response in obstructive sleep apnea. J Clin Sleep Med. 2014;10(9):943–9.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Tsuiki S, Kobayashi M, Namba K, Oka Y, Komada Y, Kagimura T, et al. Optimal positive airway pressure predicts oral appliance response to sleep apnoea. Eur Respir J. 2010;35(5):1098–105.

    Article  CAS  PubMed  Google Scholar 

  117. Storesund A, Johansson A, Bjorvatn B, Lehmann S. Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea. Sleep Breath. 2018;22(2):385–92.

    Article  PubMed  Google Scholar 

  118. Cooke ME, Battagel JM. A thermoplastic mandibular advancement device for the management of non-apnoeic snoring: a randomized controlled trial. Eur J Orthod. 2006;28(4):327–38.

    Article  PubMed  Google Scholar 

  119. Dieltjens M, Verbruggen AE, Braem MJ, Wouters K, Verbraecken JA, De Backer WA, et al. Determinants of objective compliance during oral appliance therapy in patients with sleep-disordered breathing: a prospective clinical trial. JAMA Otolaryngol Head Neck Surg. 2015;141(10):894–900.

    Article  PubMed  Google Scholar 

  120. Godoy LBM, Palombini L, Poyares D, Dal-Fabbro C, Guimaraes TM, Klichouvicz PC, et al. Long-term oral appliance therapy improves daytime function and mood in upper airway resistance syndrome patients. Sleep. 2017;40(12)

    Google Scholar 

  121. Tegelberg A, Nohlert E, Bergman LE, Andren A. Bed partners’ and patients’ experiences after treatment of obstructive sleep apnoea with an oral appliance. Swed Dent J. 2012;36(1):35–44.

    PubMed  Google Scholar 

  122. Richter K, Adam S, Geiss L, Peter L, Niklewski G. Two in a bed: the influence of couple sleeping and chronotypes on relationship and sleep. An overview. Chronobiol Int. 2016;33(10):1464–72.

    Article  PubMed  PubMed Central  Google Scholar 

  123. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    Article  CAS  PubMed  Google Scholar 

  124. Eiseman NA, Westover MB, Mietus JE, Thomas RJ, Bianchi MT. Classification algorithms for predicting sleepiness and sleep apnea severity. J Sleep Res. 2012;21(1):101–12.

    Article  PubMed  Google Scholar 

  125. Arnardottir ES, Bjornsdottir E, Olafsdottir KA, Benediktsdottir B, Gislason T. Obstructive sleep apnoea in the general population: highly prevalent but minimal symptoms. Eur Respir J. 2016;47(1):194–202.

    Article  PubMed  Google Scholar 

  126. Deegan PC, McNicholas WT. Predictive value of clinical features for the obstructive sleep apnoea syndrome. Eur Respir J. 1996;9(1):117–24.

    Article  CAS  PubMed  Google Scholar 

  127. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94.

    Article  PubMed  Google Scholar 

  128. Heinzer R, Marti-Soler H, Haba-Rubio J. Prevalence of sleep apnoea syndrome in the middle to old age general population. Lancet Respir Med. 2016;4(2):e5–6.

    Article  PubMed  Google Scholar 

  129. Gao YN, Wu YC, Lin SY, Chang JZ, Tu YK. Short-term efficacy of minimally invasive treatments for adult obstructive sleep apnea: A systematic review and network meta-analysis of randomized controlled trials. J Formos Med Assoc. 2019;118(4):750–65.

    Article  PubMed  CAS  Google Scholar 

  130. Koretsi V, Eliades T, Papageorgiou SN. Oral interventions for obstructive sleep apnea. Dtsch Arztebl Int. 2018;115(12):200–7.

    PubMed  PubMed Central  Google Scholar 

  131. Antic NA, Catcheside P, Buchan C, Hensley M, Naughton MT, Rowland S, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life, and neurocognitive function in patients with moderate to severe OSA. Sleep. 2011;34(1):111–9.

    Article  PubMed  PubMed Central  Google Scholar 

  132. Verbruggen AE, Dieltjens M, Wouters K, De Volder I, Van de Heyning PH, Braem MJ, et al. Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing. Sleep Med. 2014;15(2):269–72.

    Article  CAS  PubMed  Google Scholar 

  133. Kazemeini E, Braem MJ, Moorkens G, Balina S, Kastoer C, Op de Beeck S, et al. Scoring of hypersomnolence and fatigue in patients with obstructive sleep apnea treated with a titratable custom-made mandibular advancement device. J Clin Sleep Med. 2019;15(4):623–8.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Saletu A, Anderer P, Parapatics S, Matthai C, Matejka M, Saletu B. Effects of a mandibular repositioning appliance on sleep structure, morning behavior and clinical symptomatology in patients with snoring and sleep-disordered breathing. Neuropsychobiology. 2007;55(3–4):184–93.

    Article  CAS  PubMed  Google Scholar 

  135. Roux FJ. Restless legs syndrome: impact on sleep-related breathing disorders. Respirology. 2013;18(2):238–45.

    Article  PubMed  Google Scholar 

  136. Saaresranta T, Hedner J, Bonsignore MR, Riha RL, McNicholas WT, Penzel T, et al. Clinical phenotypes and comorbidity in European sleep Apnoea patients. PLoS One. 2016;11(10):e0163439.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  137. Suzuki K, Miyamoto M, Miyamoto T, Numao A, Suzuki S, Sakuta H, et al. Sleep apnoea headache in obstructive sleep apnoea syndrome patients presenting with morning headache: comparison of the ICHD-2 and ICHD-3 beta criteria. J Headache Pain. 2015;16:56.

    Article  PubMed  PubMed Central  Google Scholar 

  138. Nerfeldt P, Friberg D. Effectiveness of oral appliances in obstructive sleep apnea with respiratory arousals. J Clin Sleep Med. 2016;12(8):1159–65.

    Article  PubMed  PubMed Central  Google Scholar 

  139. Jessen NA, Munk AS, Lundgaard I, Nedergaard M. The glymphatic system: a beginner’s guide. Neurochem Res. 2015;40(12):2583–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  140. Bratton DJ, Gaisl T, Wons AM, Kohler M. CPAP vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: a systematic review and meta-analysis. JAMA. 2015;314(21):2280–93.

    Article  CAS  PubMed  Google Scholar 

  141. Liu T, Li W, Zhou H, Wang Z. Verifying the relative efficacy between continuous positive airway pressure therapy and its alternatives for obstructive sleep apnea: a network meta-analysis. Front Neurol. 2017;8:289.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK. Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med. 2013;9(2):165–74.

    Article  PubMed  PubMed Central  Google Scholar 

  143. Andren A, Hedberg P, Walker-Engstrom ML, Wahlen P, Tegelberg A. Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial. Sleep Breath. 2013;17(2):705–12.

    Article  PubMed  Google Scholar 

  144. Dal-Fabbro C, Garbuio S, D'Almeida V, Cintra FD, Tufik S, Bittencourt L. Mandibular advancement device and CPAP upon cardiovascular parameters in OSA. Sleep Breath. 2014;18(4):749–59.

    Article  PubMed  Google Scholar 

  145. Gotsopoulos H, Kelly JJ, Cistulli PA. Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep. 2004;27(5):934–41.

    Article  PubMed  Google Scholar 

  146. Rietz H, Franklin KA, Carlberg B, Sahlin C, Marklund M. Nocturnal blood pressure is reduced by a mandibular advancement device for sleep apnea in women: findings from secondary analyses of a randomized trial. J Am Heart Assoc. 2018;7(13)

    Google Scholar 

  147. Lam B, Sam K, Lam JC, Lai AY, Lam CL, Ip MS. The efficacy of oral appliances in the treatment of severe obstructive sleep apnea. Sleep Breath. 2011;15(2):195–201.

    Article  PubMed  Google Scholar 

  148. Trzepizur W, Gagnadoux F, Abraham P, Rousseau P, Meslier N, Saumet JL, et al. Microvascular endothelial function in obstructive sleep apnea: impact of continuous positive airway pressure and mandibular advancement. Sleep Med. 2009;10(7):746–52.

    Article  PubMed  Google Scholar 

  149. Andren A, Sjoquist M, Tegelberg A. Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance – a three-year follow-up. J Oral Rehabil. 2009;36(10):719–25.

    Article  CAS  PubMed  Google Scholar 

  150. Sekizuka H, Osada N, Akashi YJ. Effect of oral appliance therapy on blood pressure in Japanese patients with obstructive sleep apnea. Clin Exp Hypertens. 2016;38(4):404–8.

    Article  CAS  PubMed  Google Scholar 

  151. Yoshida K. Effect on blood pressure of oral appliance therapy for sleep apnea syndrome. Int J Prosthodont. 2006;19(1):61–6.

    PubMed  Google Scholar 

  152. Zhang LQ, Zheng X, Wang JL, Wang YZ, Ren B, He B. Effects of oral appliance treatment upon blood pressure in mild to moderate obstructive sleep apnea-hypopnea syndrome. Zhonghua Yi Xue Za Zhi. 2009;89(26):1807–10.

    PubMed  Google Scholar 

  153. Otsuka R, Ribeiro de Almeida F, Lowe AA, Linden W, Ryan F. The effect of oral appliance therapy on blood pressure in patients with obstructive sleep apnea. Sleep Breath. 2006;10(1):29–36.

    Article  PubMed  Google Scholar 

  154. Anandam A, Patil M, Akinnusi M, Jaoude P, El-Solh AA. Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study. Respirology. 2013;18(8):1184–90.

    Article  PubMed  Google Scholar 

  155. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompre PH, Lavigne GJ. Mandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5–4.5 years. Sleep Med. 2011;12(9):844–9.

    Article  PubMed  Google Scholar 

  156. Sheats RD, Schell TG, Blanton AO, Braga PM, Demko BG, Dort LC, et al. Management of side effects of oral appliance therapy for sleep disordered breathing. J Dent Sleep Med. 2017;In Press.

    Google Scholar 

  157. Nakamura S, Sato M, Mataki S, Kurosaki N, Hasegawa M. Subjective and objective assessments of short-term adverse effects induced by oral appliance therapy in obstructive sleep apnea: a preliminary study. J Med Dent Sci. 2009;56(1):37–48.

    PubMed  Google Scholar 

  158. Otsuka R, Almeida FR, Lowe AA. The effects of oral appliance therapy on occlusal function in patients with obstructive sleep apnea: a short-term prospective study. Am J Orthod Dentofac Orthop. 2007;131(2):176–83.

    Article  Google Scholar 

  159. Cohen-Levy J, Petelle B, Pinguet J, Limerat E, Fleury B. Forces created by mandibular advancement devices in OSAS patients: a pilot study during sleep. Sleep Breath. 2013;17(2):781–9.

    Article  CAS  PubMed  Google Scholar 

  160. Lee JS, Choi HI, Lee H, Ahn SJ, Noh G. Biomechanical effect of mandibular advancement device with different protrusion positions for treatment of obstructive sleep apnoea on tooth and facial bone: a finite element study. J Oral Rehabil. 2018;45(12):948–58.

    Article  PubMed  Google Scholar 

  161. Gonzalez M, Macias-Escalada E, Cobo J, Fernandez Mondragon MP, Gomez-Moreno G, Martinez-Martinez M, et al. Can treatment with statins have a negative influence on the tolerance of mandibular advancement devices? Sleep Breath. 2016;20(4):1363–6.

    Article  PubMed  Google Scholar 

  162. Cunali PA, Almeida FR, Santos CD, Valdrichi NY, Nascimento LS, Dal-Fabbro C, et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath. 2011;15(4):717–27.

    Article  PubMed  Google Scholar 

  163. Ishiyama H, Inukai S, Nishiyama A, Hideshima M, Nakamura S, Tamaoka M, et al. Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: a randomized, double-blind, placebo-controlled trial. J Prosthodont Res. 2017;61(3):259–67.

    Article  PubMed  Google Scholar 

  164. Ueda H, Almeida FR, Chen H, Lowe AA. Effect of 2 jaw exercises on occlusal function in patients with obstructive sleep apnea during oral appliance therapy: a randomized controlled trial. Am J Orthod Dentofac Orthop. 2009;135(4):430 e1–7; discussion -1.

    Google Scholar 

  165. de Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, et al. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1(2):143–52.

    Article  PubMed  Google Scholar 

  166. Fritsch KM, Iseli A, Russi EW, Bloch KE. Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med. 2001;164(5):813–8.

    Article  CAS  PubMed  Google Scholar 

  167. Gong X, Zhang J, Zhao Y, Gao X. Long-term therapeutic efficacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome. Angle Orthod. 2013;83(4):653–8.

    Article  PubMed  Google Scholar 

  168. Martinez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C. Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod. 2010;80(1):30–6.

    Article  PubMed  PubMed Central  Google Scholar 

  169. Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999;22(2):237–40.

    Article  CAS  PubMed  Google Scholar 

  170. Wang X, Gong X, Yu Z, Gao X, Zhao Y. Follow-up study of dental and skeletal changes in patients with obstructive sleep apnea and hypopnea syndrome with long-term treatment with the Silensor appliance. Am J Orthod Dentofac Orthop. 2015;147(5):559–65.

    Article  Google Scholar 

  171. Doff MH, Veldhuis SK, Hoekema A, Slater JJ, Wijkstra PJ, de Bont LG, et al. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. Clin Oral Investig. 2012;16(3):689–97.

    Article  PubMed  Google Scholar 

  172. Perez CV, de Leeuw R, Okeson JP, Carlson CR, Li HF, Bush HM, et al. The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath. 2013;17(1):323–32.

    Article  PubMed  Google Scholar 

  173. Napankangas R, Raunio A, Sipila K, Raustia A. Effect of mandibular advancement device therapy on the signs and symptoms of temporomandibular disorders. J Oral Maxillofac Res. 2013;3(4):e5.

    PubMed  PubMed Central  Google Scholar 

  174. Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 2. Study-model analysis. Am J Orthod Dentofac Orthop. 2006;129(2):205–13.

    Article  Google Scholar 

  175. Hammond RJ, Gotsopoulos H, Shen G, Petocz P, Cistulli PA, Darendeliler MA. A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea. Am J Orthod Dentofac Orthop. 2007;132(6):806–14.

    Article  Google Scholar 

  176. Marklund M, Franklin KA, Persson M. Orthodontic side-effects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod. 2001;23(2):135–44.

    Article  CAS  PubMed  Google Scholar 

  177. Marklund M. Subjective versus objective dental side effects from oral sleep apnea appliances. Sleep Breath. 2020;24(1):111–7.

    Article  PubMed  Google Scholar 

  178. Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 1. Cephalometric analysis. Am J Orthod Dentofac Orthop. 2006;129(2):195–204.

    Article  Google Scholar 

  179. Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol. 2005;30(2):149–56.

    Article  CAS  PubMed  Google Scholar 

  180. Bondemark L. Does 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible? Am J Orthod Dentofac Orthop. 1999;116(6):621–8.

    Article  CAS  Google Scholar 

  181. Doff MH, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LG, Stegenga B. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig. 2013;17(2):475–82.

    Article  CAS  PubMed  Google Scholar 

  182. Doff MH, Hoekema A, Pruim GJ, Huddleston Slater JJ, Stegenga B. Long-term oral-appliance therapy in obstructive sleep apnea: a cephalometric study of craniofacial changes. J Dent. 2010;38(12):1010–8.

    Article  CAS  PubMed  Google Scholar 

  183. Fransson AM, Tegelberg A, Johansson A, Wenneberg B. Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device: a 2-year follow-up. Am J Orthod Dentofac Orthop. 2004;126(6):687–93.

    Article  Google Scholar 

  184. Hou HM, Sam K, Hagg U, Rabie AB, Bendeus M, Yam LY, et al. Long-term dentofacial changes in Chinese obstructive sleep apnea patients after treatment with a mandibular advancement device. Angle Orthod. 2006;76(3):432–40.

    CAS  PubMed  Google Scholar 

  185. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofac Orthop. 2006;129(2):214–21.

    Article  Google Scholar 

  186. Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med. 2014;10(12):1285–91.

    Article  PubMed  PubMed Central  Google Scholar 

  187. Robertson C, Herbison P, Harkness M. Dental and occlusal changes during mandibular advancement splint therapy in sleep disordered patients. Eur J Orthod. 2003;25(4):371–6.

    Article  PubMed  Google Scholar 

  188. Rose EC, Staats R, Virchow C Jr, Jonas IE. Occlusal and skeletal effects of an oral appliance in the treatment of obstructive sleep apnea. Chest. 2002;122(3):871–7.

    Article  PubMed  Google Scholar 

  189. Fransson AMC, Kowalczyk A, Isacsson G. A prospective 10-year follow-up dental cast study of patients with obstructive sleep apnoea/snoring who use a mandibular protruding device. Eur J Orthod. 2017;39(5):502–8.

    PubMed  Google Scholar 

  190. Fransson AM, Tegelberg A, Svenson BA, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofac Orthop. 2002;122(4):371–9.

    Article  Google Scholar 

  191. Ringqvist M, Walker-Engstrom ML, Tegelberg A, Ringqvist I. Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. Am J Orthod Dentofac Orthop. 2003;124(1):53–60.

    Article  Google Scholar 

  192. Marklund M. Long-term efficacy of an oral appliance in early treated patients with obstructive sleep apnea. Sleep Breath. 2016;20(2):689–94.

    Article  PubMed  Google Scholar 

  193. Ueda H, Almeida FR, Lowe AA, Ruse ND. Changes in occlusal contact area during oral appliance therapy assessed on study models. Angle Orthod. 2008;78(5):866–72.

    Article  PubMed  Google Scholar 

  194. Venema JAM, Stellingsma K, Doff M. Dental side effects of long term obstructive sleep apnea therapy. A 10 year follow up study. J Dent Seep Med. 2018;5(2):39–46.

    Google Scholar 

  195. Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang B. Three-dimensional computer-assisted study model analysis of long-term oral-appliance wear. Part 2. Side effects of oral appliances in obstructive sleep apnea patients. Am J Orthod Dentofac Orthop. 2008;134(3):408–17.

    Article  Google Scholar 

  196. Norrhem N, Nemeczek H, Marklund M. Changes in lower incisor irregularity during treatment with oral sleep apnea appliances. Sleep Breath. 2017;21(3):607–13.

    Article  PubMed  PubMed Central  Google Scholar 

  197. Marklund M, Legrell PE. An orthodontic oral appliance. Angle Orthod. 2010;80(6):1116–21.

    Article  PubMed  PubMed Central  Google Scholar 

  198. Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA. Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. Chest. 2010;138(4):870–4.

    Article  PubMed  Google Scholar 

  199. Almeida FR, Parker JA, Hodges JS, Lowe AA, Ferguson KA. Effect of a titration polysomnogram on treatment success with a mandibular repositioning appliance. J Clin Sleep Med. 2009;5(3):198–204.

    Article  PubMed  PubMed Central  Google Scholar 

  200. Hamoda MM, Almeida FR, Pliska BT. Long-term side effects of sleep apnea treatment with oral appliances: nature, magnitude and predictors of long-term changes. Sleep Med. 2019;56:184–91.

    Article  PubMed  Google Scholar 

  201. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15(6):343–56.

    Article  PubMed  PubMed Central  Google Scholar 

  202. Vanderveken OM, Dieltjens M, Wouters K, De Backer WA, Van de Heyning PH, Braem MJ. Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing. Thorax. 2013;68(1):91–6.

    Article  PubMed  Google Scholar 

  203. Dieltjens M, Braem MJ, Vroegop AV, Wouters K, Verbraecken JA, De Backer WA, et al. Objectively measured vs self-reported compliance during oral appliance therapy for sleep-disordered breathing. Chest. 2013;144(5):1495–502.

    Article  PubMed  Google Scholar 

  204. Smith YK, Verrett RG. Evaluation of a novel device for measuring patient compliance with oral appliances in the treatment of obstructive sleep apnea. J Prosthodont. 2014;23(1):31–8.

    Article  PubMed  Google Scholar 

  205. Benoist L, de Ruiter M, de Lange J, de Vries N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Med. 2017;34:109–17.

    Article  PubMed  Google Scholar 

  206. Schwab RJ, Badr SM, Epstein LJ, Gay PC, Gozal D, Kohler M, et al. An official American Thoracic Society statement: continuous positive airway pressure adherence tracking systems. The optimal monitoring strategies and outcome measures in adults. Am J Respir Crit Care Med. 2013;188(5):613–20.

    Article  PubMed  PubMed Central  Google Scholar 

  207. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, et al. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147(4):887–95.

    Article  CAS  PubMed  Google Scholar 

  208. Pepin JL, Krieger J, Rodenstein D, Cornette A, Sforza E, Delguste P, et al. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med. 1999;160(4):1124–9.

    Article  CAS  PubMed  Google Scholar 

  209. Peker Y, Glantz H, Eulenburg C, Wegscheider K, Herlitz J, Thunstrom E. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea. The RICCADSA Randomized Controlled Trial. Am J Respir Crit Care Med. 2016;194(5):613–20.

    Article  CAS  PubMed  Google Scholar 

  210. Vanderveken OM, Braem MJ, Dieltjens M, De Backer WA, Van de Heyning PH. Objective measurement of the therapeutic effectiveness of continuous positive airway pressure versus oral appliance therapy for the treatment of obstructive sleep apnea. Am J Respir Crit Care Med. 2013;188(9):1162.

    Article  PubMed  Google Scholar 

  211. Attali V, Chaumereuil C, Arnulf I, Golmard JL, Tordjman F, Morin L, et al. Predictors of long-term effectiveness to mandibular repositioning device treatment in obstructive sleep apnea patients after 1000 days. Sleep Med. 2016;27-28:107–14.

    Article  PubMed  Google Scholar 

  212. Haviv Y, Zini A, Almoznino G, Keshet N, Sharav Y, Aframian DJ. Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea. Oral Dis. 2017;23(5):629–35.

    Article  CAS  PubMed  Google Scholar 

  213. Wiman Eriksson E, Leissner L, Isacsson G, Fransson A. A prospective 10-year follow-up polygraphic study of patients treated with a mandibular protruding device. Sleep Breath. 2015;19(1):393–401.

    Article  PubMed  Google Scholar 

  214. Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath. 2018;22(3):555–68.

    Article  PubMed  Google Scholar 

  215. Nishigawa K, Hayama R, Matsuka Y. Complications causing patients to discontinue using oral appliances for treatment of obstructive sleep apnea. J Prosthodont Res. 2017;61(2):133–8.

    Article  PubMed  Google Scholar 

  216. Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration. 2011;82(2):162–8.

    Article  CAS  PubMed  Google Scholar 

  217. Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJ, de Bont LG, et al. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep. 2013;36(9):1289–96.

    Article  PubMed  PubMed Central  Google Scholar 

  218. Fransson AM, Tegelberg A, Leissner L, Wenneberg B, Isacsson G. Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: a 2-year follow-up. Sleep Breath. 2003;7(3):131–41.

    Article  PubMed  Google Scholar 

  219. Marklund M, Sahlin C, Stenlund H, Persson M, Franklin KA. Mandibular advancement device in patients with obstructive sleep apnea : long-term effects on apnea and sleep. Chest. 2001;120(1):162–9.

    Article  CAS  PubMed  Google Scholar 

  220. Rose EC, Barthlen GM, Staats R, Jonas IE. Therapeutic efficacy of an oral appliance in the treatment of obstructive sleep apnea: a 2-year follow-up. Am J Orthod Dentofac Orthop. 2002;121(3):273–9.

    Article  Google Scholar 

  221. Walker-Engstrom ML, Tegelberg A, Wilhelmsson B, Ringqvist I. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study. Chest. 2002;121(3):739–46.

    Article  PubMed  Google Scholar 

  222. Bonsignore MR, Baiamonte P, Mazzuca E, Castrogiovanni A, Marrone O. Obstructive sleep apnea and comorbidities: a dangerous liaison. Multidiscip Respir Med. 2019;14:8.

    Article  PubMed  PubMed Central  Google Scholar 

  223. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.

    Article  PubMed  PubMed Central  Google Scholar 

  224. Ravesloot MJ, van Maanen JP, Dun L, de Vries N. The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea-a review of the literature. Sleep Breath. 2013;17(1):39–49.

    Article  CAS  PubMed  Google Scholar 

  225. Eijsvogel MM, Ubbink R, Dekker J, Oppersma E, de Jongh FH, van der Palen J, et al. Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. J Clin Sleep Med. 2015;11(2):139–47.

    Article  PubMed  PubMed Central  Google Scholar 

  226. Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG. Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med. 2011;7(4):376–83.

    Article  PubMed  PubMed Central  Google Scholar 

  227. de Ruiter MHT, Benoist LBL, de Vries N, de Lange J. Durability of treatment effects of the sleep position trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep Breath. 2018;22(2):441–50.

    Article  PubMed  Google Scholar 

  228. Levendowski D, Cunnington D, Swieca J, Westbrook P. User compliance and behavioral adaptation associated with supine avoidance therapy. Behav Sleep Med. 2018;16(1):27–37.

    Article  PubMed  Google Scholar 

  229. Joosten SA, O’Donoghue FJ, Rochford PD, Barnes M, Hamza K, Churchward TJ, et al. Night-to-night repeatability of supine-related obstructive sleep apnea. Ann Am Thorac Soc. 2014;11(5):761–9.

    Article  PubMed  Google Scholar 

  230. Kulkas A, Muraja-Murro A, Tiihonen P, Mervaala E, Toyras J. Morbidity and mortality risk ratios are elevated in severe supine dominant OSA: a long-term follow-up study. Sleep Breath. 2015;19(2):653–60.

    Article  PubMed  Google Scholar 

  231. Dieltjens M, Vroegop AV, Verbruggen AE, Wouters K, Willemen M, De Backer WA, et al. A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath. 2015;19(2):637–44.

    Article  PubMed  Google Scholar 

  232. Almeida FR, Mulgrew A, Ayas N, Tsuda H, Lowe AA, Fox N, et al. Mandibular advancement splint as short-term alternative treatment in patients with obstructive sleep apnea already effectively treated with continuous positive airway pressure. J Clin Sleep Med. 2013;9(4):319–24.

    Article  PubMed  PubMed Central  Google Scholar 

  233. Borel JC, Gakwaya S, Masse JF, Melo-Silva CA, Series F. Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients. Respir Physiol Neurobiol. 2012;183(2):170–6.

    Article  PubMed  Google Scholar 

  234. Kaminska M, Montpetit A, Mathieu A, Jobin V, Morisson F, Mayer P. Higher effective oronasal versus nasal continuous positive airway pressure in obstructive sleep apnea: effect of mandibular stabilization. Can Respir J. 2014;21(4):234–8.

    Article  PubMed  PubMed Central  Google Scholar 

  235. Liu HW, Chen YJ, Lai YC, Huang CY, Huang YL, Lin MT, et al. Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD. PLoS One. 2017;12(10):e0187032.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  236. Gagnadoux F, Le Vaillant M, Paris A, Pigeanne T, Leclair-Visonneau L, Bizieux-Thaminy A, et al. Relationship between OSA clinical phenotypes and CPAP treatment outcomes. Chest. 2016;149(1):288–90.

    Article  PubMed  Google Scholar 

  237. Ye L, Pien GW, Ratcliffe SJ, Bjornsdottir E, Arnardottir ES, Pack AI, et al. The different clinical faces of obstructive sleep apnoea: a cluster analysis. Eur Respir J. 2014;44(6):1600–7.

    Article  PubMed  PubMed Central  Google Scholar 

  238. Haviv Y, Bachar G, Aframian DJ, Almoznino G, Michaeli E, Benoliel R. A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study. Oral Dis. 2015;21(3):386–92.

    Article  CAS  PubMed  Google Scholar 

  239. Gauthier L, Almeida F, Arcache JP, Ashton-McGregor C, Cote D, Driver HS, et al. Position paper by Canadian dental sleep medicine professionals on the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances. Can Respir J. 2012;19(5):307–9.

    Article  PubMed  PubMed Central  Google Scholar 

  240. Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006;29(2):240–3.

    Article  PubMed  Google Scholar 

  241. Levrini L, Sacchi F, Milano F, Polimeni A, Cozza P, Bernkopf E, et al. Italian recommendations on dental support in the treatment of adult obstructive sleep apnea syndrome [OSAS]. Ann Stomatol (Roma). 2015;6(3–4):81–6.

    Google Scholar 

  242. Netzer NCC, Ancoli-Israel SC-C, Bliwise DL, Fulda S, Roffe C, Almeida F, et al. Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the international geriatric sleep medicine task force. Eur Respir J. 2016;48(4):992–1018.

    Article  Google Scholar 

  243. Ngiam J, Balasubramaniam R, Darendeliler MA, Cheng AT, Waters K, Sullivan CE. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Aust Dent J. 2013;58(4):408–19.

    Article  CAS  PubMed  Google Scholar 

  244. Stradling J, Dookun R. Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol. Br Dent J. 2009;206(6):307–12.

    Article  CAS  PubMed  Google Scholar 

  245. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22(5):667–89.

    Google Scholar 

  246. Marti-Soler H, Hirotsu C, Marques-Vidal P, Vollenweider P, Waeber G, Preisig M, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4(9):742–8.

    Article  PubMed  Google Scholar 

  247. McNicholas WT, Bonsignore MR, Levy P, Ryan S. Mild obstructive sleep apnoea: clinical relevance and approaches to management. Lancet Respir Med. 2016;4(10):826–34.

    Article  PubMed  Google Scholar 

  248. Bonsignore MR, Randerath W, Riha R, Smyth D, Gratziou C, Goncalves M, et al. New rules on driver licensing for patients with obstructive sleep apnoea: EU directive 2014/85/EU. Eur Respir J. 2016;47(1):39–41.

    Article  PubMed  Google Scholar 

  249. Lazard DS, Blumen M, Levy P, Chauvin P, Fragny D, Buchet I, et al. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009;5(5):431–8.

    Article  PubMed  PubMed Central  Google Scholar 

  250. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep. 2009;32(5):648–53.

    Article  PubMed  PubMed Central  Google Scholar 

  251. Dort L, Brant R. A randomized, controlled, crossover study of a noncustomized tongue retaining device for sleep disordered breathing. Sleep Breath. 2008;12(4):369–73.

    Article  PubMed  Google Scholar 

  252. Yanagihara M, Tsuiki S, Setoguchi Y, Inoue Y. Treatment of obstructive sleep apnea with a tongue-stabilizing device at a single multidisciplinary sleep center. JDSM. 2016;3(2):43–7.

    Article  Google Scholar 

  253. Chen H, Lowe AA, Strauss AM, de Almeida FR, Ueda H, Fleetham JA, et al. Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients. Sleep Breath. 2008;12(2):169–78.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The author certifies that she has no affiliations with or involvement in any organization or entity with any financial interest, except for a consultancy fee from ResMed, or non-financial interest in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

  1. Department of Odontology, Medical Faculty, Umeå University, Umeå, Sweden

    Marie Marklund

Authors
  1. Marie Marklund
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie Marklund .

Editor information

Editors and Affiliations

  1. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Ki Beom Kim

  2. Orthodontics, Saint Louis University Orthodontics, Saint Louis, MO, USA

    Reza Movahed

  3. Washington University in St. Louis School of Medicine, Saint Louis, MO, USA

    Raman K. Malhotra

  4. Otolaryngology-Head and Neck Surgery, University of Michigan–Ann Arbor, Ann Arbor, MI, USA

    Jeffrey J. Stanley

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Marklund, M. (2021). Oral Appliance Therapy. In: Kim, K.B., Movahed, R., Malhotra, R.K., Stanley, J.J. (eds) Management of Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-030-54146-0_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-54146-0_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-54145-3

  • Online ISBN: 978-3-030-54146-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation