Q: What I am looking for are data that support use of any oral appliance for treatment of obstructive sleep apnea, especially where the appliance(s) is compared to CPAP. Evidently there are some discrepancy issues in billing and the use of codes, which has caused the issue to be raised. I’ve done a literature search and am looking for any solid evidence and if its out there, I would welcome it.
Dr. Smith: OK, here are some articles, Ross.
1. http://ajrccm.atsjournals.org/cgi/content/full/163/6/1294 (not compared to CPAP)
2. SLEEP 1995;18:501-10 Oral Appliances For The Treatment Of Snoring And Obstructive Sleep Apnea: A Review
Summary: This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee’s parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea.
3. http://findarticles.com/p/articles/mi_hb4345/is_3_35/ai_n29337679 (compares to CPAP)
4. http://www.journalsleep.org./ViewAbstract.aspx?pid=26465 Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review
Abstract:
We conducted an evidence-based review of literature regarding use of oral appliances (OAs) in the treatment of snoring and obstructive sleep apnea syndrome (OSA) from 1995 until the present. Our structured search revealed 141 articles for systematic scrutiny, of which 87 were suitable for inclusion in the evidence base, including 15 Level I to II randomized controlled trials and 5 of these trials with placebo-controlled treatment. The efficacy of OAs was established for controlling OSA in some but not all patients with success (defined as no more than 10 apneas or hypopneas per hour of sleep) achieved in an average of 52% of treated patients. Effects on sleepiness and quality of life were also demonstrated, but improvements in other neurocognitive outcomes were not consistent. The mechanism of OA therapy is related to opening of the upper airway as demonstrated by imaging and physiologic monitoring. Treatment adherence is variable with patients reporting using the appliance a median of 77% of nights at 1 year. Minor adverse effects were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use, but the long-term dental significance of this is uncertain. In comparison to continuous positive airway pressure (CPAP), OAs are less efficacious in reducing the apnea hypopnea index (AHI), but OAs appear to be used more (at least by self report), and in many studies were preferred over CPAP when the treatments were compared. OAs have also been compared favorably to surgical modification of the upper airway (uvulopalatopharyngoplasty, UPPP). Comparisons between OAs of different designs have produced variable findings. The literature of OA therapy for OSA now provides better evidence for the efficacy of this treatment modality and considerable guidance regarding the frequency of adverse effects and the indications for use in comparison to CPAP and UPPP.
Citation: Ferguson KA; Cartwright R; Rogers R et al. Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review. SLEEP 2006;29(2): 244-262.
5. http://www.springerlink.com/content/j4w6r21256314131/fulltext.pdf Review of oral appliances for treatment of sleep-disordered breathing
Abstract Between 1982 and 2006, there were 89 distinct
publications dealing with oral appliance therapy involving a
total of 3,027 patients, which reported results of sleep studies
performed with and without the appliance. These studies,
which constitute a very heterogeneous group in terms of
methodology and patient population, are reviewed and the
results summarized. This review focused on the following
outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea
index or respiratory disturbance index), ability of oral
appliances to reduce snoring, effect of oral appliances on
daytime function, comparison of oral appliances with other
treatments (continuous positive airway pressure and surgery),
side effects, dental changes (overbite and overjet), and
long-term compliance
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