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01 May 2006 | Australasian Dental Practice

news > Spectrum > Page 46

New guidelines endorse the use of oral appliances for obstructive sleep apnea

New practice parameters published by the American Academy of Sleep Medicine in the medical journal Sleep now endorse the use of oral appliances for treatment of snoring and mild-moderate obstructive sleep apnea (OSA). The move is seen as good news for millions of OSA sufferers as it enables them to avoid the risks associated with surgery and the discomfort that can accompany other treatment methods.

Signs and symptoms

Loud snoring is often a sign of obstructive sleep apnea, which blocks the airway and results in sleep disruption. It occurs when the tongue and soft tissues in the back of the throat collapse to block the airway during sleep, producing pauses in breathing that can occur a few times or several hundred times a night, disrupting sleep. OSA can cause:

  • Excessive daytime sleepiness;
  • An increased risk of high blood pressure; and
  • Higher rates of stroke, arrhythmias and heart attacks.

OSA can be life threatening: Treating it is important

"Oral appliances may help people who have tried other OSA treatments and been unsuccessful or who have not complied with their treatment," said Dr Lawrence Epstein, president of the American Academy of Sleep Medicine.

"OSA is a serious, life-threatening condition - but for many patients, alleviating its effects can be as easy as utilising an oral appliance at night," explains Dr Kent Moore, president of the Academy of Dental Sleep Medicine. "Oral appliances, which resemble sports mouth guards, may control mild to moderate OSA with minimal discomfort or disruption."

This practice parameter is based on an accompanying review of extensive evidence found in the scientific literature that was performed by an expert task force.

While continuous positive airway pressure (CPAP) is still considered the most efficacious treatment for OSA, many patients find this form of treatment uncomfortable or intolerable, making an oral appliance often a more appropriate option. The new practice parameters (and accompanying review paper) validate the effectiveness of oral appliances as a viable treatment alternative for those patients with mild to moderate OSA who either prefer it to CPAP, or are unable to successfully comply with CPAP treatment. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering oral appliances.

According to Dr Moore, oral appliances offer a safe, effective and non-invasive treatment option for many of the 30 million Americans suffering from OSA and severe, chronic snoring. When utilised during sleep, they help maintain an open and unobstructed airway in the throat by repositioning or stabilising the lower jaw, tongue, soft palate or uvula. There are many types of oral appliances, with some designed specifically for snoring and others intended to treat both snoring and sleep apnea.

"This is a significant change in the practice guidelines for the medical profession because it confirms the role of oral appliances as an effective form of treatment for mild and moderate obstructive sleep apnea," said Robert Dravers, General Manager at SomnoMed Ltd. "No longer can CPAP devices be claimed to be the only effective treatment for sleep apnea. Only severe sleep apnea sufferers - a small percentage of the total - may not be suitable for oral appliances like SomnoMed's Mandibular Advancement Splint (MAS)."

SomnoMed listed on the Australian Stock Exchange in late 2004 and immediately began marketing and manufacturing the SomnoMed MAS to treat snoring and light-to-moderate obstructive sleep apnea. In February this year, the company expanded internationally and opened its North American headquarters in Denton, Texas.

"Snoring affects about half the overall population and the United States represents about 56 percent of the world's snoring market," said John Truitt, Chief Executive Officer of SomnoMed USA. "Our device is ideally suited to assist sufferers so we hope to build on the success we have had in Australia over here. The initial feedback we've received so far has been very good."

Facts about snoring and obstructive sleep apnea:

  • An estimated 30 million - or one in eight - Americans snore;
  • Snorers have a high likelihood of having (or developing) obstructive sleep apnea;
  • Approximately 18 million Americans suffer from sleep apnea;
  • Some 28% of men over the age of 65 suffer from sleep apnea;
  • Up to 50% of sleep apnea patients have high blood pressure;
  • Risk for heart attack and stroke also may increase among those who have sleep apnea;
  • Nearly 60% of Americans suffer from daytime sleepiness, a side effect of sleep apnea;
  • Snoring and mild-moderate apnea is improved and often eliminated in many patients who use oral appliances;
  • Each year, sleep disorders add an estimated $15.9 billion to the US healthcare bill.

Sources: American Academy of Sleep Medicine, American Sleep Apnea Association and National Sleep Foundation

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