Oral appliances for obstructive sleep apnoea

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Otolaryngology

Background:

• Obstructive sleep apnoea-hypopnoea (OSAHS) involves recurrent upper airway obstruction during sleep, often treated with nasal continuous positive airway pressure (CPAP).
• Many patients struggle with CPAP compliance, necessitating alternative treatments like oral appliances.
• Oral appliances offer a potential alternative for managing OSAHS.

Purpose of the Study:

• To systematically review the efficacy of oral appliances in treating adult sleep apnoea.
• To compare oral appliances against control treatments, CPAP, and surgery.

Main Methods:

• Searched the Cochrane Airways Group Sleep Apnoea RCT Register and reference lists (up to June 2004).
• Included randomized controlled trials comparing oral appliances with control or other treatments in adults with sleep apnoea.
• Assessed trial quality and extracted data independently, contacting authors for missing information.

Main Results:

• Thirteen trials with 553 participants were included, though studies had limitations (small sample size, lack of blinding).
• Oral appliances reduced daytime sleepiness and improved the apnoea-hypopnoea index (AHI) compared to control appliances.
• Oral appliances were less effective than CPAP in reducing AHI, but symptom scores showed no significant difference. CPAP improved oxygen saturation more effectively. Patients often preferred oral appliances to CPAP.
• Surgery showed initial benefits for sleepiness and AHI over oral appliances, but these differences diminished over 12 months.

Conclusions:

• Oral appliances demonstrate effectiveness in improving subjective sleepiness and sleep-disordered breathing compared to controls.
• Nasal CPAP remains more effective for improving sleep-disordered breathing than oral appliances.
• Oral appliance therapy is best reserved for patients with sleep apnoea who cannot tolerate or comply with CPAP, pending further evidence.