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Oral Appliance Therapy for Sleep-Disordered Breathing

  • Joachim Ngiam
  • Kate Sutherland
  • Ramesh Balasubramaniam
  • Marie Marklund
  • Fernanda Almeida
  • Peter Cistulli
Living reference work entry

Abstract

Obstructive sleep apnea (OSA) is characterized by repetitive obstruction of the upper airway during sleep, resulting in sleep fragmentation and nocturnal oxygen desaturation. As a result, patients may present with signs and symptoms of daytime sleepiness, neurocognitive impairment, and cardiovascular morbidity and mortality. Mandibular advancement appliances (oral appliance mandibular, OAm) are recommended for patients with mild-to-moderate OSA, and for those with severe OSA, where continuous positive airway pressure is refused or not tolerated. The mechanism of action of OAm is based on holding the mandible in a protrusive position and hence reducing pharyngeal collapsibility during sleep. Two-thirds of patients show a minimum of 50% reduction in the apnea-hypopnea index (AHI) with OAm treatment. Further, OAm have been shown to have a positive effect on blood pressure and endothelial function that are markers of cardiovascular health. Despite OAm being inferior in therapeutic efficacy to CPAP in reducing the AHI, its higher compliance might translate to similar adjusted AHI and clinical effectiveness. There are side effects with OAm use, such as bite changes and jaw pain; however, most side effects are transient and rarely significant in the long term.

Keywords

Obstructive sleep apnea Snoring Oral appliance Tongue stabilizing appliance Apnea-hypopnea index 

References

  1. 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.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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 Dentofacial Orthop. 2006a;129(2):205–13.PubMedCrossRefGoogle Scholar
  4. 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 Dentofacial Orthop. 2006b;129(2):195–204.PubMedCrossRefGoogle Scholar
  5. 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.PubMedPubMedCentralGoogle Scholar
  6. Almeida FR, Tsuiki S, Hattori Y, Takei Y, Inoue Y, Lowe AA. Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea. Eur Respir J. 2011;37(1):209–12.PubMedCrossRefGoogle Scholar
  7. Almeida FR, Mulgrew A, Ayas N, Tsuda H, Lowe AA, Fox N, Harrison S, Fleetham JA. 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.PubMedPubMedCentralGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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. 2012;17:705.PubMedCrossRefGoogle Scholar
  10. Athanasiou AE, Papadopoulos MA, Mazaheri M, Lagoudakis M. Cephalometric evaluation of pharynx, soft palate, adenoid tissue, tongue, and hyoid bone following the use of a mandibular repositioning appliance in obstructive sleep apnea patients. Int J Adult Orthodon Orthognath Surg. 1994;9(4):273–83.PubMedGoogle Scholar
  11. Barnes M, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. AJRCCM. 2004;170(6):656–64.Google Scholar
  12. Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol. 2005;30(2):149–56.PubMedCrossRefGoogle Scholar
  13. Blanco J, Zamarron C, Abeleira Pazos MT, Lamela C, Suarez Quintanilla D. Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath. 2005;9(1):20–5.PubMedCrossRefGoogle Scholar
  14. Bloch KE, Iseli A, Zhang JN, Xie X, Kaplan V, Stoeckli PW, Russi EW. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med. 2000;162(1):246–51.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Carrara S, Rodrigues Contill P, Stuginski Barbosa J III. Statement of the 1st consensus on temporomandibular disorders and orofacial pain. Dent Press J Orthod. 2010;15(3):114–20.CrossRefGoogle Scholar
  18. Chan AS, Lee RW, Srinivasan VK, Darendeliler MA, Grunstein RR, Cistulli PA. Nasopharyngoscopic evaluation of oral appliance therapy for obstructive sleep apnoea. Eur Respir J. 2010a;35(4):836–42.PubMedCrossRefGoogle Scholar
  19. Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, Darendeliler MA, Cistulli PA. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax. 2010b;65(8):726–32.PubMedCrossRefGoogle Scholar
  20. Chan AS, Lee RW, Srinivasan VK, Darendeliler MA, Cistulli PA. Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea: a prospective validation study. Sleep Breath. 2011;15(2):157–62.PubMedCrossRefGoogle Scholar
  21. 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 Dentofacial Orthop. 2008a;134(3):408–17.PubMedCrossRefGoogle Scholar
  22. Chen H, Lowe AA, Strauss AM, de Almeida FR, Ueda H, Fleetham JA, Wang B. Dental changes evaluated with a 3D computer-assisted model analysis after long-term tongue retaining device wear in OSA patients. Sleep Breath. 2008b;12(2):169–78.PubMedCrossRefGoogle Scholar
  23. Chen H, Almeida FR, Lowe AA. Dental changes associated with tongue retaining device wear. Sleep Breath. 2009;13(1):111–2.CrossRefGoogle Scholar
  24. Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N, Patel SR, Patil S, Knight SL, Rowley JA, Slyman A, ATS Ad Hoc Committee on Mild Obstructive Sleep Apnea. An official American Thoracic Society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med. 2016;193(9):e37–54.PubMedCrossRefGoogle Scholar
  25. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  26. Cistulli PA, Sutherland K. Deep phenotyping in obstructive sleep apnea. A step closer to personalized therapy. Am J Respir Crit Care Med. 2016;194(11):1317–8.PubMedCrossRefGoogle Scholar
  27. Clark GT, et al. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest. 1996;109(6):1477–86.Google Scholar
  28. Clark GT, Sohn JW, Hong CN. Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device. J Am Dent Assoc. 2000;131(6):765–71.PubMedCrossRefGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. College of Dental Surgeons of British Columbia. Obstructive sleep apnea. The role of dentists in the treatment of snoring and obstructive sleep apnea with oral appliances. https://www.cdsbc.org/CDSBCPublicLibrary/Obstructive-Sleep-Apnea.pdf (2014)
  31. Cunali PA, Almeida FR, Santos CD, Valdrichi NY, Nascimento LS, Dal-Fabbro C, Tufik S, Bittencourt LR. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath. 2011;15(4):717–27.PubMedCrossRefGoogle Scholar
  32. de Almeida FR, Bittencourt LR, de Almeida CI, Tsuiki S, Lowe AA, Tufik S. Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance. Sleep. 2002;25(5):507–13.PubMedCrossRefGoogle Scholar
  33. de Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, Ryan F. 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.PubMedGoogle Scholar
  34. De Leeuw R, Klasser G. American Academy of Orofacial Pain. Orofacial pain: guidelines for assessment, diagnosis, and management. 5th ed. Chicago: Quintessence Publishing; 2013.Google Scholar
  35. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Dieltjens M, Braem MJ, Vroegop AV, Wouters K, Verbraecken JA, De Backer WA, Van de Heyning PH, Vanderveken OM. Objectively measured vs self-reported compliance during oral appliance therapy for sleep-disordered breathing. Chest. 2013;144(5):1495–502.Google Scholar
  37. Dieltjens M, Vroegop AV, Verbruggen AE, Wouters K, Willemen M, De Backer WA, Verbraecken JA, Van de Heyning PH, Braem MJ, de Vries N, Vanderveken OM. A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath. 2015;19(2):637–44.PubMedCrossRefGoogle Scholar
  38. 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.PubMedCrossRefGoogle Scholar
  39. Doff MH, Veldhuis SK, Hoekema A, Slater JJ, Wijkstra PJ, de Bont LG, Stegenga B. 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.Google Scholar
  40. 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.PubMedCrossRefGoogle Scholar
  41. Dort LC, Hussein J. Snoring and obstructive sleep apnea: compliance with oral appliance therapy. J Otolaryngol. 2004;33(3):172–6.PubMedCrossRefGoogle Scholar
  42. El-Solh AA, Moitheennazima B, Akinnusi ME, Churder PM, Lafornara AM. Combined oral appliance and positive airway pressure therapy for obstructive sleep apnea: a pilot study. Sleep Breath. 2011;15(2):203–8.PubMedCrossRefGoogle Scholar
  43. Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, Mackay TW, Douglas NJ. 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.PubMedCrossRefGoogle Scholar
  44. Ferguson FA, et al. 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.Google Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. Flanagan D. A removable snore reduction appliance for a mandibular edentulous patient. J Oral Implantol. 2009;35(5):221–4.PubMedCrossRefGoogle Scholar
  47. Fleury B, Rakotonanahary D, Petelle B, Vincent G, Pelletier Fleury N, Meyer B, Lebeau B. Mandibular advancement titration for obstructive sleep apnea: optimization of the procedure by combining clinical and oximetric parameters. Chest. 2004;125(5):1761–7.PubMedCrossRefGoogle Scholar
  48. 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.PubMedCrossRefGoogle Scholar
  49. Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, N’Guyen XL, Trzepizur W, Racineux JL. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34(4):914–20.PubMedCrossRefGoogle Scholar
  50. Gagnadoux F, Pepin JL, Vielle B, Bironneau V, Chouet-Girard F, Launois S, Meslier N, Meurice JC, Nguyen XL, Paris A, Priou P, Tamisier R, Trzepizur W, Goupil F, Fleury B. Impact of mandibular advancement therapy on endothelial function in severe obstructive sleep apnea. Am J Respir Crit Care Med. 2017;195:1244.PubMedCrossRefGoogle Scholar
  51. Gauthier L, Almeida F, Arcache JP, Ashton-McGregor C, Cote D, Driver HS, Ferguson KA, Lavigne GJ, Martin P, Masse JF, Morisson F, Pancer J, Samuels CH, Schachter M, Series F, Sullivan GE. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  52. Gindre L, Gagnadoux F, Meslier N, Gustin JM, Racineux JL. Mandibular advancement for obstructive sleep apnea: dose effect on apnea, long-term use and tolerance. Respiration. 2008;76(4):386–92.PubMedCrossRefGoogle Scholar
  53. 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.PubMedCrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. 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 Dentofacial Orthop. 2007;132(6):806–14.PubMedCrossRefGoogle Scholar
  56. Henke KG, Frantz DE, Kuna ST. An oral elastic mandibular advancement device for obstructive sleep apnea. Am J Respir Crit Care Med. 2000;161(2 Pt 1):420–5.PubMedCrossRefGoogle Scholar
  57. Hoekema A, de Vries F, Heydenrijk K, Stegenga B. Implant-retained oral appliances: a novel treatment for edentulous patients with obstructive sleep apnea-hypopnea syndrome. Clin Oral Implants Res. 2007;18(3):383–7.PubMedCrossRefGoogle Scholar
  58. Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007;11(1):1–22.Google Scholar
  59. 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.PubMedCrossRefGoogle Scholar
  60. Hou HM, Sam K, Hagg U, Rabie AB, Bendeus M, Yam LY, Ip MS. Long-term dentofacial changes in Chinese obstructive sleep apnea patients after treatment with a mandibular advancement device. Angle Orthod. 2006;76(3):432–40.PubMedGoogle Scholar
  61. 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.PubMedPubMedCentralGoogle Scholar
  62. Inoko Y, Yoshimura K, Kato C, Morita O, Kohno M. Efficacy and safety of temperature loggers in measuring complianc with the use of oral appliances. Sleep Biol Rhythm. 2009;7:188–92.CrossRefGoogle Scholar
  63. Johal A, Battagel JM, Kotecha BT. Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea. Eur J Orthod. 2005;27(6):607–14.PubMedCrossRefGoogle Scholar
  64. Johal A, Gill G, Ferman A, McLaughlin K. The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea. Clin Physiol Funct Imaging. 2007;27(1):47–53.PubMedCrossRefGoogle Scholar
  65. 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.PubMedCrossRefGoogle Scholar
  66. Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, Nishino T. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest. 2000;117(4):1065–72.PubMedCrossRefGoogle Scholar
  67. Krishnan V, Collop NA, Scherr SC. An evaluation of a titration strategy for prescription of oral appliances for obstructive sleep apnea. Chest. 2008;133(5):1135–41.PubMedCrossRefGoogle Scholar
  68. Kuna ST, Giarraputo PC, Stanton DC, Levin LM, Frantz D. Evaluation of an oral mandibular advancement titration appliance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(5):593–603.PubMedCrossRefGoogle Scholar
  69. Kuna ST, Woodson LC, Solanki DR, Esch O, Frantz DE, Mathru M. Effect of progressive mandibular advancement on pharyngeal airway size in anesthetized adults. Anesthesiology. 2008;109(4):605–12.PubMedPubMedCentralCrossRefGoogle Scholar
  70. Kurtulmus H, Cotert S, Bilgen C, On AY, Boyacioglu H. The effect of a mandibular advancement splint on electromyographic activity of the submental and masseter muscles in patients with obstructive sleep apnea. Int J Prosthodont. 2009;22(6):586–93.PubMedGoogle Scholar
  71. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499–521.PubMedCrossRefGoogle Scholar
  72. Lazard DS, Blumen M, Levy P, Chauvin P, Fragny D, Buchet I, Chabolle F. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009;5(5):431–8.PubMedPubMedCentralGoogle Scholar
  73. Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD, Wheatley JR. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep. 2008;31(9):1207–13.PubMedPubMedCentralGoogle Scholar
  74. Lee CH, Jung HJ, Lee WH, Rhee CS, Yoon IY, Yun PY, Kim JW. The effect of positional dependency on outcomes of treatment with a mandibular advancement device. Arch Otolaryngol Head Neck Surg. 2012;138(5):479–83.PubMedCrossRefGoogle Scholar
  75. 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.PubMedPubMedCentralGoogle Scholar
  76. Lowe AA, Sjoholm TT, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE. Treatment, airway and compliance effects of a titratable oral appliance. Sleep. 2000;23(Suppl 4):S172–8.PubMedGoogle Scholar
  77. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2006;129(2):214–21.PubMedCrossRefGoogle Scholar
  78. 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.PubMedCrossRefGoogle Scholar
  79. Marklund M, Legrell PE. An orthodontic oral appliance. Angle Orthod. 2010;80(6):1116–21.PubMedCrossRefGoogle Scholar
  80. 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.PubMedCrossRefGoogle Scholar
  81. 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.PubMedCrossRefGoogle Scholar
  82. 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.PubMedCrossRefGoogle Scholar
  83. 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.PubMedCrossRefGoogle Scholar
  84. 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.PubMedCrossRefGoogle Scholar
  85. McGown AD, Makker HK, Battagel JM, L’Estrange PR, Grant HR, Spiro SG. Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey. Eur Respir J. 2001;17(3):462–6.PubMedCrossRefGoogle Scholar
  86. 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.PubMedCrossRefGoogle Scholar
  87. Millman RP, Rosenberg CL, Carlisle CC, Kramer NR, Kahn DM, Bonitati AE. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty. Chest. 1998;113(4):992–6.PubMedCrossRefGoogle Scholar
  88. 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.PubMedGoogle Scholar
  89. 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.PubMedGoogle Scholar
  90. 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.PubMedPubMedCentralGoogle Scholar
  91. Ng AT, Gotsopoulos H, Qian J, Cistulli PA. Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med. 2003;168(2):238–41.PubMedCrossRefGoogle Scholar
  92. 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.PubMedGoogle Scholar
  93. Ng AT, Darendeliler MA, Petocz P, Cistulli PA. Cephalometry and prediction of oral appliance treatment outcome. Sleep Breath. 2012;16(1):47–58.PubMedCrossRefGoogle Scholar
  94. 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.PubMedCrossRefGoogle Scholar
  95. Oliven R, Tov N, Odeh M, Gaitini L, Steinfeld U, Schwartz AR, Oliven A. Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea. J Appl Physiol (1985). 2009;106(5):1668–73.CrossRefGoogle Scholar
  96. 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 Dentofacial Orthop. 2007;131(2):176–83.PubMedCrossRefGoogle Scholar
  97. 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.PubMedCrossRefGoogle Scholar
  98. Peppard PE, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidermiol. 2013;177(9):1006–14.Google Scholar
  99. Perez CV, de Leeuw R, Okeson JP, Carlson CR, Li HF, Bush HM, Falace DA. 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.PubMedCrossRefGoogle Scholar
  100. Petelle B, Vincent G, Gagnadoux F, Rakotonanahary D, Meyer B, Fleury B. One-night mandibular advancement titration for obstructive sleep apnea syndrome: a pilot study. Am J Respir Crit Care Med. 2002;165(8):1150–3.PubMedCrossRefGoogle Scholar
  101. 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.PubMedCrossRefGoogle Scholar
  102. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, Marks GB, Cistulli PA. 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.PubMedCrossRefGoogle Scholar
  103. 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.PubMedCrossRefGoogle Scholar
  104. Pliska BT, Nam H, Chen H, Lowe A, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med. 2014;10(12):1285–91.PubMedPubMedCentralGoogle Scholar
  105. Principles and practice sleep medicine. Oral appliances for the treatment of obstructive sleep apnea-hypopnea syndrome and for concomitant sleep bruxism. 6th ed. Elsevier; 2017. p. 1445–57. ISBN 978-0-323-24288-2Google Scholar
  106. Quinnell TG, Bennett M, Jordan J, Clutterbuck-James AL, Davies MG, Smith IE, Oscroft N, Pittman MA, Cameron M, Chadwick R, Morrell MJ, Glover MJ, Fox-Rushby JA, Sharples LD. A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO). Thorax 2014;69:938–945Google Scholar
  107. 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 Clin Sleep Med. 2015;11(7):773–827.PubMedPubMedCentralGoogle Scholar
  108. Randerath WJ, et al. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest. 2002;122(2):569–75.Google Scholar
  109. Raphaelson MA, Alpher EJ, Bakker KW, Perlstrom JR. Oral appliance therapy for obstructive sleep apnea syndrome: progressive mandibular advancement during polysomnography. Cranio. 1998;16(1):44–50.PubMedCrossRefGoogle Scholar
  110. Remmers J, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, Bruehlmann S. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Sleep. 2013;36(10):1517–25. 1525APubMedPubMedCentralCrossRefGoogle Scholar
  111. 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 Dentofacial Orthop. 2003;124(1):53–60.PubMedCrossRefGoogle Scholar
  112. 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.PubMedCrossRefGoogle Scholar
  113. 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.PubMedCrossRefGoogle Scholar
  114. Schiffman E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6–27.Google Scholar
  115. Shen HL, Wen YW, Chen NH, Liao YF. Craniofacial morphologic predictors of oral appliance outcomes in patients with obstructive sleep apnea. J Am Dent Assoc. 2012;143(11):1209–17.PubMedCrossRefGoogle Scholar
  116. Sutherland K, Phillips CL, Davies A, Srinivasan VK, Dalci O, Yee BJ, Darendeliler MA, Grunstein RR, Cistulli PA. CPAP pressure for prediction of oral appliance treatment response in obstructive sleep apnea. J Clin Sleep Med. 2014a;10(9):943–9.PubMedPubMedCentralGoogle Scholar
  117. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli PA. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med. 2014b;10(2):215–27.PubMedPubMedCentralGoogle Scholar
  118. Sutherland K, Phillips CL, Cistulli PA. Efficacy versus effectiveness in the treatment of obstructive sleep apnea: CPAP and oral appliances. J Dent Sleep Med. 2015a;2(4):175–81.CrossRefGoogle Scholar
  119. 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. 2015b;11(8):861–8.PubMedPubMedCentralGoogle Scholar
  120. 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.PubMedPubMedCentralCrossRefGoogle Scholar
  121. Tan YK, L’Estrange PR, Luo YM, Smith C, Grant HR, Simonds AK, Spiro SG, Battagel JM. 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.PubMedCrossRefGoogle Scholar
  122. Tegelberg A, Walker-Engstrom ML, Vestling O, Wilhelmsson B. Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea. Acta Odontol Scand. 2003;61(6):356–62.PubMedCrossRefGoogle Scholar
  123. Trzepizur W, Gagnadoux F, Abraham P, Rousseau P, Meslier N, Saumet JL, Racineux JL. Microvascular endothelial function in obstructive sleep apnea: impact of continuous positive airway pressure and mandibular advancement. Sleep Med. 2009;10(7):746–52.PubMedCrossRefGoogle Scholar
  124. Tsai WH, Vazquez JC, Oshima T, Dort L, Roycroft B, Lowe AA, Hajduk E, Remmers JE. Remotely controlled mandibular positioner predicts efficacy of oral appliances in sleep apnea. Am J Respir Crit Care Med. 2004;170(4):366–70.PubMedCrossRefGoogle Scholar
  125. Tsuda H, Almeida FR, Masumi S, Lowe AA. Side effects of boil and bite type oral appliance therapy in sleep apnea patients. Sleep Breath. 2010a;14(3):227–32.PubMedCrossRefGoogle Scholar
  126. 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. 2010b;138(4):870–4.PubMedCrossRefGoogle Scholar
  127. Tsuiki S, Kobayashi M, Namba K, Oka Y, Komada Y, Kagimura T, Inoue Y. Optimal positive airway pressure predicts oral appliance response to sleep apnoea. Eur Respir J. 2010;35(5):1098–105.PubMedCrossRefGoogle Scholar
  128. Tsuiki S, Ito E, Isono S, Ryan CF, Komada Y, Matsuura M, Inoue Y. Oropharyngeal crowding and obesity as predictors of oral appliance treatment response to moderate obstructive sleep apnea. Chest. 2013;144(2):558–63.PubMedCrossRefGoogle Scholar
  129. 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.PubMedCrossRefGoogle Scholar
  130. 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 Dentofacial Orthop. 2009;135(4):430.e1–7; discussion 430–1.Google Scholar
  131. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH. 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.PubMedCrossRefGoogle Scholar
  132. 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.PubMedCrossRefGoogle Scholar
  133. 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 Dentofacial Orthop. 2015;147(5):559–65.PubMedCrossRefGoogle Scholar
  134. Yoshida K. Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and snoring on respiratory function and sleep quality. Cranio. 2000;18(2):98–105.PubMedCrossRefGoogle Scholar
  135. Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. Sleep. 2001;24(5):538–44.PubMedCrossRefGoogle Scholar
  136. Zeng B, Ng AT, Darendeliler MA, Petocz P, Cistulli PA. Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea. Am J Respir Crit Care Med. 2007;175(7):726–30.PubMedCrossRefGoogle Scholar
  137. Zeng B, Ng AT, Qian J, Petocz P, Darendeliler MA, Cistulli PA. Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep. 2008;31(4):543–7.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Her Majesty the Queen in Right of Australia 2018

Authors and Affiliations

  • Joachim Ngiam
    • 1
  • Kate Sutherland
    • 1
    • 2
  • Ramesh Balasubramaniam
    • 3
  • Marie Marklund
    • 4
  • Fernanda Almeida
    • 5
  • Peter Cistulli
    • 1
    • 2
  1. 1.Centre for Sleep Health and Research, Department of Respiratory & Sleep MedicineRoyal North Shore Hospital, Northern Sydney Local Health DistrictSt LeonardsAustralia
  2. 2.Charles Perkins Centre and Northern Clinical SchoolUniversity of SydneySydneyAustralia
  3. 3.UWA Dental School, University of Western AustraliaNedlandsAustralia
  4. 4.Department of OrthodonticsUmeå UniversityUmeåSweden
  5. 5.Department of Oral Health Sciences, Faculty of DentistryThe University of British ColumbiaVancouverCanada

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