The definition of an oral appliance according to the American Association of Dental Sleep Medicine is as follows:
The purpose of an oral appliance is to treat obstructive sleep apnea (OSA), primary snoring, and associated symptoms. Oral appliances are intended to decrease the frequency and/or duration of apneas, hypopneas, respiratory effort related arousals (RERAs) and/or snoring events. Oral appliances have been demonstrated to improve nocturnal oxygenation as well as the adverse health and social consequences of OSA and snoring. Oral appliances are indicated for patients with mild to moderate OSA and primary snoring. Oral appliances are accepted therapy for patients with severe OSA who do not respond to, or are unable or unwilling to tolerate, positive airway pressure (PAP) therapies. Although oral appliances are typically used as a stand-alone therapy, they can serve as an adjunct to PAP therapy and/or other treatment modalities for the management of OSA.
The function of an oral appliance is to protrude and help stabilise the mandible to maintain a patent upper airway during sleep. Current literature provides robust evidence that custom, adjustable, dual-arch mandibular advancement oral appliances are highly efficacious for the treatment of snoring and mild-moderate OSA1.
Though less efficacious than CPAP for improving AHI in moderate-severe OSA, several recent studies found that oral appliances and CPAP were equally effective at improving daytime somnolence, hypertension, neurocognitive function, quality of life indices, and cardiovascular mortality.
Though little objective adherence data is available, numerous crossover studies have demonstrated oral appliance self-reported adherence to be superior to CPAP.
Combination therapy may hold promise for those patients who are insufficiently responsive to a monotherapy.
* 1 Consensus Conference Participants: Steven C. Scherr, DDS, Moderator1 *; Leslie C. Dort, DDS, Moderator2 *; Fernanda R. Almeida, DDS, PhD3 ; Kathleen M. Bennett, DDS4 ; Norman T. Blumenstock, DDS5 ; B. Gail Demko, DMD6 ; Gregory K. Essick, DDS, PhD7 *; Sheri G. Katz, DDS8 ; Paul M. McLornan, DDS9 ; Katherine S. Phillips, DDS10*; Ronald S. Prehn, DDS11*; Robert R. Rogers, DMD12; Thomas G. Schell, DMD13; Rose D. Sheats, DMD14*; Flavia P. Sreshta, DDS15; Journal of Dental Sleep Medicine Vol 1, No 1 2014. Definition of an Effective Oral Appliance for the Treatment of OSA and Snoring.
Guidelines for the use of Oral Appliances have been published by the Board of Australasian Sleep Association.