sleep apnea replacement therapy
Philip Wilson, clinical professor at the University of New England School of Dental Medicine, was part of a team of authors of a clinical study of oral appliance therapy as an alternative to obstructive sleep apnea, recently published in the Journal of Dental Research.
The report conducted a randomized trial of 2 self-adjusting oral devices for airway management, compared two widely used oral device designs, and tested whether they differed in reducing respiratory events index - an index used to Indicates the severity of obstructive sleep apnea.
A randomized crossover study examined differences in the reduction of respiratory event indices between two oral appliances (TAP1 and SomnoDent Flex). Due to differences in design, TAP1 devices tend to limit the opening of the mouth during sleep, while the SomnoDent Flex allows the mouth to open fully. The aim was to investigate whether these design differences had differential effects, and whether oral appliance therapy played a role in the treatment of obstructive sleep apnea.
To complete the study, participants used a dentist-fitted oral appliance every night for four additional four weeks, followed by a one-week irrigation during which participants were instructed to use a ventilator for continuous positive pressure therapy. Following the rinse period, a second four-week trial was conducted, during which participants used an alternative oral appliance.
Subjects were trained on how to titrate each device, and if they observed any snoring, obstructive sleep apnea episodes, or persistent sleepiness, they should proceed to advance mandibular surgery according to each manufacturer's guidelines. To measure the respiratory event index, home sleep records were collected using a NOX T3 recorder, and oxygen saturation was measured using a oximetry probe pulse oximeter.
After nine weeks, the researchers found that the respiratory event index decay was comparable for both devices, regardless of mandibular opening, and that both designs significantly reduced the respiratory event index in patients with moderate and severe obstructive sleep apnea. Wilson said the findings were somewhat surprising given the current understanding that oral appliance therapy is only effective in patients with mild obstructive sleep apnea.
"Self-titration in as little as four weeks showed that both designs improved upper airway function and stability, reduced its collapsibility, and increased the oropharyngeal space," the team wrote. Overall, our data suggest that in patients with obstructive sleep apnea who can be offered a self-titrating oral appliance on a regular basis as a treatment option, clinicians can expect approximately 50% remission rates and a respiratory event index after 8 weeks in patients. To about 8 to 16 events per hour in patients, including patients with severe obstructive sleep apnea."