In the management of sleep disordered breathing: The physicians perspective
A Chan , R Lee, K Sutherland, P Cistulli
Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia
Oral Appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnoea (OSA). They are worn during sleep and aim to maintain the patency of the upper airway by increasing its dimensions and reducing its collapsibility. Although CPAP is a highly efficacious treatment, its obtrusive nature limits clinical effectiveness. Oral appliances are a simpler form of treatment and are often considered by patients to be more acceptable compared to CPAP. Treatment of OSA, with an oral appliance requires a multidisciplinary approach. The clinical practice parameters of the American Academy of Sleep Medicine recommend their use for mild to moderate OSA; or for patients with severe OSA who are unable to tolerate or refuse treatment with CPAP. Oral appliances have been shown to have a beneficial impact on a number of important clinical end-points including the polysomnographic indices of OSA, subjective and objective measures of sleepiness, blood pressure, aspects or neuropsychological functioning and quality of life. Elucidation of the mechanism of action of oral appliances has provided insight into the factors which predict treatment response and may improve the selection of patients for this treatment modality. Although not as efficacious as CPAP for improving the polysomnographic indices of OSA, oral appliances are often considered by patients to be a more acceptable treatment. This has the potential to translate to better treatment compliance and may provide a similar level of effectiveness in clinical practice.