Oral Appliances for Obstructive Sleep Apnea
Oral appliances made to treat obstructive sleep apnea are also called mandibular advancement devices (MADs). They are made of two pieces of acrylic that cover the upper and lower teeth, similar to a biteguard or orthodontic retainer. These pieces are connected together by some type of apparatus that allows the appliance to be adjusted. The appliances are constructed in such a way as to position and maintain the lower jaw in a forward position during sleep. This lifts the tongue away from the back of the throat, thus increasing the dimension of airway and decreasing the resistance to airflow. This is similar to the head tilt-chin lift used in basic life support to open the airway.
Types of Mandibular Advancement Devices
There are many types of MADs that are used to treat snoring and obstructive sleep apnea, however, they all accomplish the same goal. All of the appliances that we use are FDA approved for the treatment of obstructive sleep apnea and snoring. The following are pictures of the types that we use most frequently.
|Herbst Appliance||P M Positioner|
How effective are mandibular advancement devices?
The goal of oral appliance therapy is to normalize breathing during sleep, decrease snoring, improve the quality of sleep, and decrease daytime sleepiness. While many patients benefit from the use of an oral appliance, not everyone gets the same results. About 40% of patients have an excellent outcome with resulting in a normal AHI. Another 25% get some benefit but with a less than optimal outcome. The remaining 35% do not benefit at all. Chances of a successful outcome are best for patients with mild to moderate sleep apnea. Unfortunately, it is not possible to definitively predict who will have a successful outcome and who will not. However, factors that seem to increase the chances of successful treatment include having milder sleep apnea, being non-obese, having a pressure requirement of less than 10 while using CPAP, and apnea that is worse when lying on your back.
How do mandibular advancement devices compare to CPAP in effectiveness?
MADs are less effective in treating moderate to severe obstructive sleep apnea than is CPAP, however, patients tend to prefer the use of MADs over CPAP. For mild sleep apnea, MADs are about equivalent to CPAP.
Are there any side effects associated with wearing an oral appliance?
Yes. Side effects with oral appliances are rather common but are typically minor and transient. They may include jaw pain, jaw joint noises, tooth soreness, tooth mobility, tooth movement, increased or decreased saliva, and bite changes. They may also cause dislodgement of crowns or fillings. Close supervision during the first few weeks of use is necessary to help prevent or treat problems that may arise. Fortunately, most patients become accustomed to wearing an appliance after a few nights and do quite well. On occasion, these problems can be more significant and may result in an inability to wear the appliance.
Can a person with complete dentures wear an oral appliance?
Since mandibular advancement devices require teeth for retention of the appliance, patients who wear complete dentures are generally not candidates for them. However, in some instances, modifications can be made to the appliance that may allow a complete denture wearer to use these types of appliances.
For patients who do not have any teeth, there is an alternative device called a tongue retainer, which can provide the same benefits as a mandibular advancement device. Tongue retainers are composed of a bulb made of silicone, into which the tongue is extended. The bulb is then gently squeezed and released creating a suction which holds the tongue inside the bulb and in a forward position, thus lifting it off the back of the throat.
Do all snorers have sleep apnea?
No. In fact, most people who snore do not have sleep apnea, however, almost everyone with sleep apnea snores. The likelihood that a snorer has sleep apnea increases if someone has seen or heard the snorer have breathing pauses, choking, or gasping during sleep. In addition, people with sleep apnea often complain of daytime sleepiness and a poor quality of sleep. For people with simple snoring without sleep apnea, an oral appliance can help eliminate or significantly reduce snoring.