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Oral Appliances Acknowledged As A First Line Therapy Choice

December 12th, 2019   |   Posted in: Dr. Halstrom News, Education Centre, silencer-news, Uncategorized


Oral Appliance Therapy for Obstructive Sleep

Apnoea: State of the Art

Kate Sutherland 1,2,* and Peter A. Cistulli 1,2

1 Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and

Health, University of Sydney, Sydney, NSW 2006, Australia; [email protected]

2 Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia

* Correspondence: [email protected]

Received: 1 November 2019; Accepted: 27 November 2019; Published: 2 December 2019

Abstract: Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact

on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances

(OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway

to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for

OSA therapy, they are often considered only as second-line therapy following positive airway

pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP

therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A

range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep

study night, have been proposed, although none has been widely validated for clinical use.

Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not

be necessary to produce the same health benefits of PAP. This may be related to the more favourable

adherence to OA therapy, which can now be objectively verified. Data on longer term health

outcomes are needed, and there are additional opportunities for device improvement and

combination therapy approaches. OAs have an important role in precision care of OSA as a chronic

disorder through a multi-disciplinary care team. Future studies on real-world health outcomes

following OA therapy are needed.

Keywords: obstructive sleep apnoea; oral appliance; treatment effectiveness