OrthoApnea : Proven Effectiviness

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Since the eighties, when the implantation of devices were generalized, many publications of the American Academy of Sleep Medicine list the studies on the therapy of sleep apnea with oral appliances. These studies, although they constitute a very uneven collection in terms of methodology and patient population, who were studied, they all agree in showing, that the advancement of the mandible increases in light of the airway by reducing the tendency of the collapse of the pharynx.The use of functional prostheses achieves effects, that counteract the conditions causing the OSAHS, elevation of the base of the tongue, increased muscle tone of the palatoglossus, protrusion out of the soft palate, pharynx expansion, standardization and stabilization of the walls of the throat.

These results are reviewed and summarized in 2005 with the publication of an update on the parameters of practice for the treatment of snoring and sleep apnea with oral appliances.
This review focused on the following results: reduction of sleep apnea (that means reduction of apnea / hypopnea index or respiratory disturbance index), the ability of oral appliances to reduce snoring, the effect of oral appliances daytime symptoms (sleepiness), comparing oral appliances with other treatments (CPAP and surgery), side effects, dental changes (overbite), and long-term effectiveness.
It was concluded, that the success rate, defined as the ability of oral appliances to reduce sleep AHI less than 10, was 54%. The response rate, defined as at least 50% reduction in the initial AHI (although it remained above 10), is 21%. Snoring is reduced by 45%. In studies comparing oral appliances with continuous positive airway pressure (CPAP) and uvulopalatopharyngoplasty (UPPP), the intraoral device reduced initial AHI by 42%, CPAP reduced by 75% and 30% UPPP. Most patients preferred to use oral appliance versus CPAP.

The use of oral appliances improves daytime function: the Epworth sleepiness score dropped from 11.2 to 7.8 in 854 patients. A summary of the compliance monitoring data shows that in 30 months, 56-68% of patients continue using the oral appliance. Side effects are frequent, but relatively minor. Among the most common patients report excessive salivation and mild dental discomfort. However, both the effectiveness and side effects depend on the type of device of choice, the degree of protrusion, vertical opening, and other settings. This review concluded, that intraoral devices are a clear alternative to CPAP in reducing sleep apnea, snoring and sleepiness, they have a definite role in the treatment of snoring and OSA with levels of adaptation, acceptance and choice of patients exceeded the levels of other therapeutic alternatives currently available.

Another review of 2006 published results continuity with the previous review. It indicates, that oral appliances "cure" satisfactorily (significant remission of symptoms), mild to moderate OSAHS in 40-50% of patients, and further improve it significantly in the 10-20%. The authors points out, that when applications are made by qualified dentists, 50-70% of patients still using them for years. Although its efficacy is lower than the CPAP it is similar to surgical procedures, but without being an invasive or irreversible therapy. In Spain, an increasing number of studies supporting the efficacy of intraoral appliances with comparable results in groups of patients with symptomatic improvements achieved with CPAP. In 2000, Monasterio et al, conducted a study in 21 patients to evaluate a model of prosthetic mandibular advancement in the treatment of obstructive sleep apnea. The treatment was performed in 21 patients (20 men) diagnosed with OSAHS. The mean age was 51 years, body mass index of 30 kg/m2, and the rate of apnea-hypopnea per hour of 48. The test was considered successful, if the AHI reduced to < 15/hy and the associated symptoms disappear. According to the results, the study concluded that the mandibular advancement prosthesis is an effective treatment for a subgroup of patients with syndrome of obstructive sleep apnea, including some patients with higher apnea hypopnea index. now recognized that custom-made and adjustable devices (custom made) are those with greatest rate of success.

PSG Record without intraoral prosthesis

PSG Record with intraoral prosthetic

In treatment of snoring the intraoral devices have shown greater efficacy. Patients has shown a definitive disappearance in 50% or a decrease in 90-100% of cases. Snoring is also presented in a entity disease called IRSUA(syndrome of increased resistance of the airways), which coexists with snoring with total or partial airflow obstruction, with arousals, but not accompanied by desaturation. In these cases should be strongly indicated this type of apparatus. The positive pressure therapy CPAP is the treatment of choice for this problem, though intraoral devices offer an obvious comfort. However, despite that, they are less predictable, playing an important role, because of its convenience and do not cause noise, do not need power and prevent irritation of the mucosa, that normally occurs with CPAP treatment.

Therefore, intraoral devices should be used in cases of mild and moderate OSAHS, but have described cases of success in severe patients being necessary to individualize each case. Advancement appliances have higher efficacy and prefernce of use than uvulopalatopharyngoplasty surgery. It should be noted the complications that can arise with this type of surgery: velopalatal failure to produce fluid leakage through the nose, when the patient swallows, postoperative pain is usually severe or recurrence of snoring. As a secondary or rescue in these cases intraoral devices have been used successfully, obtaining good results in at least 50% of patients. The parameters, which have been linked as facialskeleton conditions can be seen as more suited to the patient as response to the overtaking equipment, so that it reduced anterior facial height, increased anterior cranial base, increased maxillary length, decreased mandibular plane, mandibular plane-hyoid distance diminished normal soft palate in thickness and occupation. The best response to intraoral appliances progress is obtained with individuals of low body mass, in young patients with reduced neck circumference also respond better to have a lower AHI and the apneic episodes are related to the supine position.