ORAL APPLIANCES USED FOR OBSTRUCTIVE SLEEP APNEA: A review

Authors

  • Janhvi Manohar Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India Author
  • Dhanraj Ganapathy Professor and H.O.D, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600077 Author
  • Kiran Kumar Pandurangan Senior Lecturer, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600077. Author
  • Ashok Velayudhan Professor and Head, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600077 Author

DOI:

https://doi.org/10.61841/v9ahdm68

Keywords:

Obstructive sleep apnea, Oral appliances, dental practitioners, mandibular advancement appliances

Abstract

Obstructive sleep apnea is a sleep disorder in which a person stops breathing periodically throughout the night due to physical obstructions of the airway, with a predilection among middle-aged males. Oral appliances are devices that can be used to treat mild or moderate obstructive sleep apnea, as well as snoring. The treatment of OSA depends on the severity of symptoms, magnitude of clinical complications, and etiology of upper airway obstruction. It can be treated by lifestyle modifications, CPAP (continuous positive airway pressure), surgery, or oral appliances. Oral appliances, which are of recent development, work by positioning the mandible in a protruded position during sleep. Oral appliances are of several types: Mandibular Advancement Splints (MAS), Mandibular Advancement Devices (MAD), Mandibular Repositioning Appliances (MRA), or Tongue Retaining Devices (TRD), which hold your tongue in place to keep your airway open while asleep, and Adjustable Soft Palate Lifters. The comparison between oral appliances of different designs and the literature of sleep apnea provides better evidence for the efficacy of this treatment modality and thus more scope for its development. The aim of this article is to review literature regarding the various types of oral appliances in the treatment of sleep apnea syndrome, their mechanism of action, factors affecting their performance, complications, and patient compliance. 

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References

1. Young T, Palta M, Dempsey J, et al. The Occurrence of Sleep-Disordered Breathing among MiddleAged Adults. New England Journal of Medicine 1993; 328: 1230–1235.

2. Gotsopoulos H, Chen C, Qian J, et al. Oral Appliance Therapy Improves Symptoms in Obstructive Sleep

Apnea. American Journal of Respiratory and Critical Care Medicine 2002; 166: 743–748.

3. Barnes M, Douglas McEvoy R, Banks S, et al. Efficacy of Positive Airway Pressure and Oral Appliance

in Mild to Moderate Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care

Medicine 2004; 170: 656–664.

4. Pandi-Perumal SR, Narasimhan M, Kramer M. Sleep and Psychosomatic Medicine. CRC Press, 2017.

5. Ferguson KA, Ono T, Lowe AA, et al. A Randomized Crossover Study of an Oral Appliance vs NasalContinuous Positive Airway Pressure in the Treatment of Mild-Moderate Obstructive Sleep Apnea.

Chest 1996; 109: 1269–1275.

6. Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 2007;

11: 1–22.

7. Ng AT, Gotsopoulos H, Qian J, et al. Effect of Oral Appliance Therapy on Upper Airway Collapsibility

in Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine 2003; 168:

238–241.

8. Venugopalan S, Ariga P, Aggarwal P, et al. Case Report: Magnetically retained silicone facial

prosthesis. Niger J Clin Pract 2014; 17: 260–264.

2. Jyothi S, Robin PK, Ganapathy D, et al. Periodontal health status of three different groups wearing

temporary partial denture. Research Journal of Pharmacy and Technology 2017; 10: 4339–4342.

3. Duraisamy R, Krishnan CS, Ramasubramanian H, et al. Compatibility of Nonoriginal Abutments With

Implants: Evaluation of Microgap at the Implant–Abutment Interface, With Original and Nonoriginal

Abutments. Implant Dent 2019; 28: 289.

4. Kannan A, Others. Effect of Coated Surfaces influencing Screw Loosening in Implants: A Systematic

Review and Meta-analysis. WORLD 2017; 8: 496–502.

5. Ashok V, Suvitha S. Awareness of all ceramic restoration in rural population. Research Journal of

Pharmacy and Technology 2016; 9: 1691–1693.

6. Ajay R, Suma K, Ali SA, et al. Effect of Surface Modifications on the Retention of Cement-retained

Implant Crowns under Fatigue Loads: An In vitro Study. J Pharm Bioallied Sci 2017; 9: S154–S160.

7. Jain AR, Nallaswamy D, Ariga P, et al. Determination of correlation of width of maxillary anterior teeth

using extraoral and intraoral factors in Indian population: A systematic review. World J Dent 2018; 9:

68–75.

8. Ganapathy D, Sathyamoorthy A, Ranganathan H, et al. Effect of Resin Bonded Luting Agents

Influencing Marginal Discrepancy in All Ceramic Complete Veneer Crowns. J Clin Diagn Res 2016; 10:

ZC67–ZC70.

9. Ranganathan H, Ganapathy DM, Jain AR. Cervical and Incisal Marginal Discrepancy in Ceramic

Laminate Veneering Materials: A SEM Analysis. Contemp Clin Dent 2017; 8: 272–278.

10. Selvan SR, Ganapathy D. Efficacy of fifth generation cephalosporins against methicillin-resistant

Staphylococcus aureus-A review. Research Journal of Pharmacy and Technology 2016; 9: 1815–1818.

11. Subasree S, Murthykumar K, Others. Effect of Aloe Vera in Oral Health-A Review. Research Journal of

Pharmacy and Technology 2016; 9: 609–612.

12. Basha FYS, Ganapathy D, Venugopalan S. Oral Hygiene Status among Pregnant Women. Research

Journal of Pharmacy and Technology 2018; 11: 3099–3102.

13. Kannan A, Venugopalan S. A systematic review on the effect of use of impregnated retraction cords on

gingiva. Research Journal of Pharmacy and Technology 2018; 11: 2121–2126.

14. Vijayalakshmi B, Ganapathy D. Medical management of cellulitis. Research Journal of Pharmacy and

Technology 2016; 9: 2067–2070.

15. Robin P. A fall of the base of the tongue considered as a new cause of nasopharyngeal respiratory

impairment. Bull Acad Natl Med 1923; 89: 37.

16. Robin P. GLOSSOPTOSIS DUE TO ATRESIA AND HYPOTROPHY OF THE MANDIBLE. Am J

Dis Child 1934; 48: 541–547.

17. Dentists D, Apnea S. History of dental sleep medicine. Journal of Dental Sleep Medicine Vol 2014; 1:

67.

18. Cartwright RD, Samelson CF. The effects of a nonsurgical treatment for obstructive sleep apnea. The

tongue-retaining device. JAMA 1982; 248: 705–709.

19. Hoekema A, Stegenga B, De Bont LGM. Efficacy and co-morbidity of oral appliances in the treatment

of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev Oral Biol Med 2004; 15: 137–155.

20. Ono T, Lowe AA, Ferguson KA, et al. The effect of the tongue retaining device on awake genioglossus

muscle activity in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1996; 110:

28–35.

21. Ono T, Lowe AA, Ferguson KA, et al. A tongue retaining device and sleep-state genioglossus muscle

activity in patients with obstructive sleep apnea. Angle Orthod 1996; 66: 273–280.

22. Mageet AO. Intraoral Appliances for the Treatment of Obstructive Sleep ApnoeaHypopnoea Syndrome.

EC Dental Science 2018; 17: 2198–2206.

23. Soll BA, George PT. Treatment of obstructive sleep apnea with a nocturnal airway-patency appliance. N

Engl J Med 1985; 313: 386–387.

24. George PT. A modified functional appliance for treatment of obstructive sleep apnea. J Clin Orthod

1987; 21: 171–175.

25. George PT. Still more on obstructive sleep apnea. American journal of orthodontics and dentofacial

orthopedics: official publication of the American Association of Orthodontists, its constituent societies,

and the American Board of Orthodontics 1989; 96: 29A–30A.

26. Viscomi VA, Walker JM, Farney RJ, et al. Efficacy of a dental appliance in patients with snoring and

sleep apnea. Sleep Res Online 1988; 17: 266.

27. Schmidt-Nowara WW. Body position does not affect apnea frequency. Sleep 1988; 11: 402.

28. Schmidt-Nowara WW, Meade TE, Hays MB. Treatment of snoring and obstructive sleep apnea with a

dental orthosis. Chest 1991; 99: 1378–1385.

29. Bushell MK, Baldock PJ, Antic R, et al. Obligatory nasal breathing: effects on snoring and sleep apnoea.

Med J Aust 1991; 155: 83–85.

30. Menn SJ, Loube DI, Morgan TD, et al. The mandibular repositioning device: role in the treatment of

obstructive sleep apnea. Sleep 1996; 19: 794–800.

31. LOWE, A A. Dental appliance for the treatment of snoring and/or obstructive sleep apnea. Principles

and Practice of Sleep medicine 1994; 722–735.

32. Lowe AA. The tongue and airway. Otolaryngol Clin North Am 1990; 23: 677–698.

33. Cartwright RD. The effects of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining

device. JAMA: The Journal of the American Medical Association 1982; 248: 705–709.

34. Tepper DHW. The Tepper Oral Proprioceptive Stimulator*, An Innovative Appliance Developed by Dr.

Harry W. Tepper for the Treatment of Sleep Apnea and Chronic Snoring. Great Lakes Orthodonics, Ltd.

35. Paskow H, Paskow S. Dentistry‘s role in treating sleep apnea and snoring. N J Med 1991; 88: 815–817.

36. Marklund M, Franklin KA. Dental appliances in the treatment of snoring. A comparison between an

activator, a soft-palate lifter, and a mouth-shield. Swed Dent J 1996; 20: 183–188.

37. Haze JJ. Overview of sleep disorders and the implication on dental practice. FunctOrthod 1987; 4: 15–

17.

38. Bernhold M, Bondemark L. A magnetic appliance for treatment of snoring patients with and without

obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1998; 113: 144–155.

39. Randerath WJ, Heise M, Hinz R, et al. An Individually Adjustable Oral Appliance vs Continuous

Positive Airway Pressure in Mild-to-Moderate Obstructive Sleep Apnea Syndrome. Chest 2002; 122:

569–575.

40. Lowe AA, Sjöholm TT, Ryan CF, et al. Treatment, airway and compliance effects of a titratable oral

appliance. Sleep 2000; 23 Suppl 4: S172–8.

41. O‘Sullivan RA, Hillman DR, Mateljan R, et al. Mandibular advancement splint: an appliance to treat

snoring and obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine 1995;

151: 194–198.

42. Neill A, Whyman R, Bannan S, et al. Mandibular advancement splint improves indices of obstructive

sleep apnoea and snoring but side effects are common. N Z Med J 2002; 115: 289–292.

43. Pancer J, Al-Faifi S, Al-Faifi M, et al. Evaluation of variable mandibular advancement appliance for

treatment of snoring and sleep apnea. Chest 1999; 116: 1511–1518.

44. Rose E, Staats R, Schulte-Mönting J, et al. Treatment of obstructive sleep apnea with the Karwetzky oral

appliance. Eur J Oral Sci 2002; 110: 99–105.

45. Liu Y, Lowe AA. Factors related to the efficacy of an adjustable oral appliance for the treatment of

obstructive sleep apnea. Chin J Dent Res 2000; 3: 15–23.

46. Marklund M, Persson M, Franklin KA. Treatment success with a mandibular advancement device is

related to supine-dependent sleep apnea. Chest 1998; 114: 1630–1635.

47. Ferguson KA, Cartwright R, Rogers R, et al. Oral Appliances for Snoring and Obstructive Sleep Apnea:

A Review. Sleep 2006; 29: 244–262.

48. Yoshida K. Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and

snoring on respiratory function and sleep quality. Cranio 2000; 18: 98–105.

49. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with

obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004; 125:

1270–1278.

50. Fransson AMC, Tegelberg Å, Leissner L, et al. Effects of a Mandibular Protruding Device on the Sleep

of Patients with Obstructive Sleep Apnea and Snoring Problems: A 2-Year Follow-Up. Sleep and

Breathing 2003; 7: 131–141.

51. Walker-Engström M-L, Ringqvist I, Vestling O, et al. A Prospective Randomized Study Comparing

Two Different Degrees of Mandibular Advancement with a Dental Appliance in Treatment of Severe

Obstructive Sleep Apnea. Sleep and Breathing 2003; 7: 119–130.

52. Rose E, Staats R, Virchow C, et al. A comparative study of two mandibular advancement appliances for

the treatment of obstructive sleep apnoea. Eur J Orthod 2002; 24: 191–198.

53. Esaki K, Kanegae H, Uchida T, et al. Treatment of Sleep Apnea with a New Separated Type of Dental

Appliance (Mandibular Advancing Positioner). The Kurume Medical Journal 1997; 44: 315–319.

54. Marklund M, Franklin KA, Sahlin C, et al. The effect of a mandibular advancement device on apneas

and sleep in patients with obstructive sleep apnea. Chest 1998; 113: 707–713.

55. Pitsis AJ, Ali Darendeliler M, Gotsopoulos H, et al. Effect of Vertical Dimension on Efficacy of Oral

Appliance Therapy in Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care

Medicine 2002; 166: 860–864.

56. Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive

sleep apnea. Sleep 1999; 22: 237–240.

57. Bondemark L. Does 2 years‘ nocturnal treatment with a mandibular advancement splint in adult patients

with snoring and OSAS cause a change in the posture of the mandible? American Journal of

Orthodontics and Dentofacial Orthopedics 1999; 116: 621–628.

58. Nakazawa Y, Sakamoto T, Yasutake R, et al. Treatment of Sleep Apnea with Prosthetic Mandibular

Advancement (PMA). Sleep 1992; 15: 499–504.

59. Clark GT, Arand D, Chung E, et al. Effect of Anterior Mandibular Positioning on Obstructive Sleep

Apnea. American Review of Respiratory Disease 1993; 147: 624–629.

60. Eveloff SE, Rosenberg CL, Carlisle CC, et al. Efficacy of a Herbst mandibular advancement device in

obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine 1994; 149: 905–

909.

61. Walker-Engström ML, Wilhelmsson B, Tegelberg A, et al. Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea. A prospective randomized 1-year follow-up study. J Sleep Res 2000; 9: 303–308.

62. Shadaba A, Battagel JM, Owa A, et al. Evaluation of the Herbst Mandibular Advancement Splint in the management of patients with sleep-related breathing disorders. Clinical Otolaryngology and Allied Sciences 2000; 25: 404–412.

63. Almeida FR de, de Almeida FR, Lowe AA, et al. Long-term sequelae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. American Journal of Orthodontics and Dentofacial Orthopedics 2006; 129: 205–213.

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Published

31.05.2020

How to Cite

Manohar, J., Ganapathy, D., Kumar Pandurangan, K., & Velayudhan, A. (2020). ORAL APPLIANCES USED FOR OBSTRUCTIVE SLEEP APNEA: A review. International Journal of Psychosocial Rehabilitation, 24(3), 6004-6012. https://doi.org/10.61841/v9ahdm68