For Positional Obstructive Sleep Apnea Patients, Oral Appliances As Efficacious as CPAP

Mandibular advancement splints may be a promising first-line approach for patients whose OSA is worse when sleeping on their backs.

By Peter Blais, RPSGT

For patients with positional obstructive sleep apnea (OSA)—in this study, whose ratio of lateral apnea-hypopnea index (AHI) to supine AHI was 0.5 or less—oral appliance efficacy “might be comparable to that of CPAP,” says researcher Yoshikazu Takaesu in an interview with Dental Sleep Corner. Takaesu and colleagues won runner-up for the American Academy of Dental Sleep Medicine (AADSM)’s Clinical Research Runner-up Award for their abstract on this subject, “Mandibular Advancement Splint as a Comparable Treatment to Nasal Continuous Positive Airway Pressure in Patients with Positional Obstructive Sleep Apnea.”

“There were no significant differences in baseline AHI (MAS : nCPAP = 20.6 ± 3.9/
hr : 21.3 ± 1.7/hr, p = 0.35) or in follow-up AHI (MAS : nCPAP = 4.7 ± 3.5/hr : 3.4 ± 3.7/hr, p = 0.12) between the groups. Hence the AHI was lowered with MAS to the same extent as nCPAP,” the study found. The abstract also stated, “MAS [mandibular advancement splint] treatment for this specific phenotype, positional OSA, may be a promising patient-tailored and first-line approach to OSA. The information on positional dependency should also be useful for determining the type of treatment to use immediately after OSA diagnosis.”

Yoshikazu Takaesu

Asked how the results of this study might help dentists dealing with mandibular advancement splint and positional therapies, Takaesu says: “Positional dependency could be a significant predictor for a patient’s treatment response to mandibular advancement devices (MADs). In a clinical setting, this information can help both physicians and dentists determine the most effective treatment option for sleep apnea patients.”

Takaesu says dentists should educate their patients that sleep position might play an important role in reducing the severity of their OSA symptoms during sleep, as well as affect how they respond to MAD treatment.

Additionally those treating OSA patients “should select treatment devices based not only on short-term efficacy, but also long-term effectiveness including compliance, cost-effectiveness, patient preference, and adverse events,” he says.