Complications causing patients to discontinue using oral appliances for treatment of obstructive sleep apnea

Oral appliances (OAs) are commonly used as a noninvasive treatment for obstructive sleep apnea syndrome (OSAS). These devices are worn during sleep and create mandibular anterior traction to enlarge the upper airway. Continuous use of the device is essential for the success of OA therapy, but some patients stop using the OA for various reasons. The purpose of this research was to investigate complications in OA therapy that might prevent continuous use of these devices.

The progress of 90 OSAS patients who visited Tokushima University Hospital and underwent OA therapy was investigated with a mailed questionnaire. All patients had been receiving OA therapy for more than 12 months.

Forty patients responded to the questionnaire and of these, 22 were not wearing their OA during sleep. The average period before stopping OA therapy was 9.6 months. Answers from 38 patients who were treated with two-piece Herbst^®-type oral appliances were analyzed. The main reasons for stopping OA therapy were: (1) it was bothersome to use; and (2) it did not effectively prevent sleep apnea. Comparison of OA complications between current OA users and nonusers revealed significant differences for the items "difficulty sleeping" and "stifling feeling". OA users recorded better scores for sleep quality than nonusers.

The results of this study indicate that patients discontinued OA therapy because the appliance was "bothersome to use" and because it had "little or no effect" rather than because they experienced the typical complications of OA therapy.