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Obstructive sleep apnea oral appliance therapy was effective for those with mild or moderate condition

September 30, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) For those who have obstructive sleep apnea, a standard and successful treatment is already available. But some individuals may want to seek out other options.

A recent study found that one other option appears to work well for those who have mild or moderate obstructive sleep apnea.

That other method is the use of an oral appliance, rather than CPAP.

CPAP refers to continuous positive airway pressure. It is the standard treatment for those with obstructive sleep apnea. It delivers continuous pressured air into a person's airways through use of a face mask.

"Discuss sleep apnea treatment options with your doctor."

This study, led by Michiel Doff, PhD, of the Department of Oral and Maxillofacial Surgery at University Medical Center Groningen in The Netherlands, looked at the effectiveness of using an oral appliance for sleep apnea instead of CPAP.

The oral appliance studied in this research is a different type of therapy for obstructive sleep apnea. It is called a Thornton Adjustable Positioner, and it is inserted into a person's mouth, over their teeth, to treat their sleep apnea.

The researchers tested this oral appliance and CPAP on 103 patients with obstructive sleep apnea. These participants were randomly assigned to use either CPAP or the oral appliance.

They underwent sleep studies at the start of the study and then again at one year and two years after the start of the study.

At each of these points, they also filled out standard surveys to determine how much daytime sleepiness they felt.

The researchers judged the success of a therapy by the improvement in the patients' apnea-hypopnea index (AHI). This index measures how many times patients stop breathing or slow their breathing considerably while asleep.

The AHI score a person receives represents the number of times they stop breathing for at least 10 seconds or have a certain level of decrease in blood oxygen saturation for at least 10 seconds during one hour of sleep.

A score of 5 to 15 means the adult has mild obstructive sleep apnea while a score of 15 to 30 is moderate and over 30 is severe.

In this study, successful treatment was defined as having an AHI below 5 or else a drop in AHI by at least 50 percent that results in an AHI below 20 for patients who don't have symptoms while using their therapy.

The researchers did not find major differences in the success rates of the oral appliance or the CPAP for patients who had mild to severe obstructive sleep apnea over the two-year period.

Patients using both therapies also experienced improvements in their sleep study results and in their assessments for neurobehavioral functioning.

One difference between the therapies, however, was that the AHI was lowered more in patients who were using CPAP.

Patients using CPAP also showed higher oxygen saturation levels than those using the oral appliance.

Therefore, the researchers concluded that use of the oral appliance depended on the severity of a person's condition.

"Oral appliance therapy should be considered as a viable treatment alternative to CPAP in patients with mild to moderate obstructive sleep apnea syndrome," the researchers wrote. "In patients with severe obstructive sleep apnea, CPAP remains the treatment of first choice."

William Kohler, MD,  the medical director of the Florida Sleep Institute in Spring Hill, Florida, said many patients in his practice use the oral devices to treat sleep apnea.

"Some studies have shown that the compliance rate for the oral devices is better than that of CPAP, so the oral device is a good alternative," Dr. Kohler said.

"They are very effective, and even if they didn't cure sleep apnea as well as the CPAP, if it was tolerable, something would be better than nothing at all," he said.

"In fact, some sleep centers use that as the number one therapy even over the CPAP use, though I think that's still open to controversy," he said. "It's an effective tool that needs to be considered for treatment of sleep apnea."

Dr. Kohler noted that the devices can be expensive, costing up to $2000, though insurance will usually cover this expense if a person has tried and failed with CPAP.

CPAP machines require a prescription and can cost anywhere from $150 to over $5,500. Most insurance plans will cover some or all of the expense of a CPAP machine and the mask, which ranges from $30 to $200.

This study was published in the September issue of the journal Sleep. The researchers reported no conflicts of interest. The funding was not provided by any industry sources.

Review Date: 
September 30, 2013
Last Updated:
October 10, 2013