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Oral appliances for obstructive sleep apnoea.
J Lim1, T J Lasserson, J Fleetham
12 Eyston Drive, Weybridge, Surrey, UK, KT13 0XD.
The Cochrane Database of Systematic Reviews
|October 30, 2003
Summary
Oral appliances offer a viable alternative for treating obstructive sleep apnea-hypopnea, improving daytime sleepiness and reducing apnea-hypopnea index compared to no treatment. However, nasal continuous positive airway pressure remains more effective for severe cases.
Area of Science:
- Sleep Medicine
- Respiratory Medicine
- Otolaryngology
Background:
- Obstructive sleep apnea-hypopnea (OSAHS) involves recurrent upper airway obstruction during sleep.
- Nasal continuous positive airway pressure (CPAP) is the primary OSAHS treatment, but compliance is often an issue.
- Oral appliances (OAs) present an alternative treatment modality for OSAHS.
Purpose of the Study:
- To review the efficacy of oral appliances in treating adult sleep apnea.
- To compare OA effectiveness against control treatments and CPAP.
Main Methods:
- Systematic review of randomized trials published up to July 2003.
- Searches included MEDLINE and the Cochrane Airways Group Sleep Apnea RCT Register.
- Data extraction and quality assessment were performed by two independent reviewers.
Main Results:
- Twelve trials with 509 participants were included, all with methodological limitations.
- OAs improved apnea-hypopnea index (AHI) versus inactive controls (mean difference -13.17).
- OAs reduced daytime sleepiness but were less effective than CPAP in reducing AHI and improving oxygen saturation.
Conclusions:
- Limited evidence supports OAs for improving sleepiness and sleep-disordered breathing compared to controls.
- CPAP demonstrates superior efficacy in managing sleep-disordered breathing.
- OA therapy is appropriate for patients intolerant or non-compliant with CPAP.