Efficacy of Oral Appliance Therapy in the Treatment of Severe OSA in CPAP-Resistant Cases
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Continuous positive airway pressure (CPAP) is the current standard of care for the treatment of obstructive sleep apnea (OSA). It is known that there is a low rate of adherence in many patients. Oral appliance therapy (OAT) is effective in patients with mild-to-moderate OSA. The efficacy of OAT in severe patients is unknown. The aim of this study is to evaluate treatment using an in-laboratory titration method to determine whether OAT might be appropriate for patients with severe OSA.
This is an IRB approved, retrospective study of 41 adults (mean age 51 years; 73% male) with severe OSA who were intolerant of CPAP therapy. All patients were treated with OAT (OASYS Oral–Nasal Airway System™). The sample was sub-divided into severe [Apnea–Hypopnea Index (AHI > 30 < 50)] and very severe (AHI > 50) groups. Informed consent was obtained from all patients included in the study. The device was custom fit by a dentist. After patients reported subjective symptom improvement, titration polysomnography was performed. If obstructive events were still noted after 90 min of the sleep study, an attending sleep technologist titrated the device in vivo in 1 mm increments for a maximum of 3 mm to optimize effectiveness.
For severe cases, almost half (46%) were resolved with a post-treatment AHI < 5, while two-thirds (66%) had an AHI < 10. For very severe cases, 43% were resolved with a post-treatment AHI < 5, while 64% had an AHI < 10. All findings were statistically significant (p < 0.001).
This preliminary study supports the notion that oral appliance therapy using the OASYS Oral–Nasal Airway System™ may be effective in severe cases of OSA.
KeywordsObstructive sleep apnea treatment Mandibular advancement Removable orthodontic appliances Polysomnography
American academy of sleep medicine
Body mass index
Continuous positive airway pressure
Ear nose throat
Food and drug administration
Obstructive sleep apnea
Oral appliance therapy
Rapid eye movement
Respiratory distress index
The authors are indebted to Richa Shrivastava, BS for statistical analysis; Dennis Bashaw, MLIS and G. Dave Singh, DMD PhD DDSc for manuscript preparation.
Compliance with ethical standards
Conflict of interest
This study did not receive any intra- or extramural financial support. There is no conflict of interest, off label or investigational use of any product or service discussed in this article.
- 21.Berry RB, Brooks R, Gamaldo CE et al; for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, scoring manual version 2.4. American Academy of Sleep Medicine;2017.Google Scholar
- 22.Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Dent Sleep Med. 2015;2(3):71–125.Google Scholar
- 26.Singh GD, Griffin TM, Cress SE. Biomimetic oral appliance therapy in adults with severe obstructive sleep apnea. J Sleep Disord Ther. 2016;5:1–5.Google Scholar
- 35.Jezovnik MK, Poredos P. Oxidative stress and atherosclerosis. E-journal Cardio Practice. [Internet]. 2007 [cited 2018 Feb 1];6(6). https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/Oxidative-stress-and-atherosclerosis-Title-Oxidative-stress-and-atheroscleros.