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Review
. 2019 Sep 25;28(153):190083.
doi: 10.1183/16000617.0083-2019. Print 2019 Sep 30.

Update on oral appliance therapy

Marie Marklund  1 , Marc J A Braem  2   3 , Johan Verbraecken  4   5
Affiliations
Review

Update on oral appliance therapy

Marie Marklund et al. Eur Respir Rev. .

Abstract

Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea-hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.

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Conflict of interest statement

Conflict of interest: M. Marklund reports personal fees from ResMed, outside the submitted work. Conflict of interest: M.J.A. Braem is President of the European Academy of Dental Sleep Medicine. He reports a research grant from the Flemish Government, and is an advisory board member of SomnoMed and ResMed Narval. He has also received lecture fees and travel reimbursement from dental professional organisations and national and international meeting organising committees. Conflict of interest: J. Verbraecken reports grants and personal fees from ResMed, Bioprojet and Jazz Pharmaceutics, personal fees from Philips, Sanofi, Agfa-Gevaert and Springer, and grants from AirLiquide, Westfalen Medical, SomnoMed, Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance, Heinen & Löwenstein, AstraZeneca, Accuramed, Bekaert Deslee Academy and UCB Pharma, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Various types of dental occlusion of interest for mandibular advancement device therapy.
FIGURE 2
FIGURE 2
Reduction in overjet in various studies. TAP: Thornton Anterior Positioner.
See this image and copyright information in PMC

References

    1. Marklund M, Verbraecken J, Randerath W. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J 2012; 39: 1241–1247. - PubMed
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