Side effects of boil and bite type oral appliance therapy in sleep apnea patients

Based on a mail-out questionnaire, this study analyzed compliance and side effects of one commonly used (TheraSnore) boil and bite oral appliance (OA) in patients with obstructive sleep apnea.

The questionnaire was sent to 84 patients 6 months after the delivery of the OA.

Fifty-eight percent (n = 47) of the patients returned the questionnaire. There was no significant difference in baseline data [age, body mass index (BMI), apnea-hypopnea index or the Epworth Sleepiness Scale (ESS)] between the returned and nonreturned questionnaires. Of the responding patients, 74.5% (n = 35) continued to use the appliance. Nonusers had a higher BMI and higher baseline ESS when compared with users. The majority (74.3%) of the users and 50.0% of the nonusers previously used a nasal continuous positive airway pressure machine. Some 82.9% of the users wore their OA more than 3 days a week. Of the nonusers, 77.8% stopped using the OA in the first 3 months, and the most frequent reason given was "uncomfortable." Many users complained about a dry mouth and/or excessive salivation and nonusers significantly complained more about ill-fitting appliances. Over 80% of the users experienced improvement in their snoring, daytime sleepiness, and apnea. More than 60% of the users were satisfied with OA therapy.

While this study demonstrated similar self-reported compliance as previous reports, there were different side effects from those reported for custom-made appliances. Difficulty in optimal fit is considered to be the main cause of the subsequent stopping of the use of the boil and bite appliance.