There are many device types, and otolaryngologists and dentists should work together to determine which is best for a given patient, he said, but they generally work by moving the mandible forward during sleep to help prevent airway collapse. “You’ll become a believer in oral appliances if you actually look at what these things do,” Dr. Gillespie said.
An analysis of 11 randomized controlled trials comparing OA to continuous positive airway pressure (CPAP) found that CPAP, which has high rates of nonadherence, typically gets the better results in terms of AHI, but OA yields better results in patient preference and usage (J Clin Sleep Med. 2014;10:215-227). One study found that after uvulopalatopharyngoplasty (UPPP), AHI improved at first but then regressed after three years. In cases in which an OA was also used, however, that regression tended to be prevented (Ir J Med Sci. 2015;184:329-334).
“If you look at any sleep apnea treatment across the board, it seems about two-thirds of people have a good response: Two-thirds respond well to surgery; two-thirds respond well to CPAP; two-thirds respond well to oral appliance,” Dr. Gillespie said. “Therefore, I think a combination will allow you to get a higher response.”