Mouth Devices Treat Sleep Apnea Well
Patient Compliance May Be Better Than With Air Masks
July 16, 2003 -- Untreated sleep
apnea can result in dangerous daytime sleepiness, not to mention high blood pressure, heart attack, and stroke. Though an effective treatment is available,
called continuous positive air pressure (CPAP), roughly half of patients find
the CPAP masks to be too uncomfortable to use.
Compliance seems to be higher among patients treated with
fitted dental devices that are put in place before going to bed, but the
evidence that these mouth guard-like appliances actually work has been lacking,
and exactly how they work remains unclear. Now, new research from Australia
shows them to be effective for treating even severe obstructive sleep apnea.
Improved Symptoms, Sleep Patterns
In a series of studies, Peter A. Cistulli, MD, PhD, and
colleagues from the University of New South Wales assessed one of several oral
devices used in the treatment of obstructive sleep apnea. In an investigation
involving 80 patients, two-thirds had significant improvement in nighttime
sleep patterns while using the devices. In their latest research, published in
the July issue of the American Journal of Respiratory and Critical Care
Medicine, they report that the device works by preventing the upper airway
from collapsing during sleep.
Obstructive sleep apnea results from airway blockage, which is
usually caused by the collapse of the soft tissue in the rear of the throat
during sleep. Risk factors include being male, overweight, and over the age of
People with the condition may stop breathing hundreds of times
each night, and breathing can be interrupted for a minute or more. Loud snoring
and daytime sleepiness are the most common immediate symptoms.
CPAP works by forcing air into the nose, through either a
fitted mask or nose prongs, to maintain an open airway passage. The most
effective dental devices work by pushing the lower jaw forward, thereby opening
the air passage behind the tongue. Most are custom made by dentists and are
adjusted periodically to find the most comfortable and effective position for
the individual patient.
The latest Australian study involved 10 patients with
obstructive sleep apnea who were closely observed while wearing the
custom-fitted devices for one week. The average number of obstructive events
among the patients was reduced from 25 per night without the dental appliances
to less than five with them.
Cistulli tells WebMD that the device appeared to be most
effective in the treatment of patients with mild to moderate obstructive sleep
apnea, but it has also been shown to work for many patients with severe apnea.
Although his research team has not conducted compliance studies, he says most
patients do not seem to have a problem sleeping with the devices on.
"CPAP is extremely effective, but studies show that many
patients only use it for three or four hours a night," he says. "Our patients
tell us that they are using these mouth devices all night. A partially
effective treatment that is used more may be as good as a very effective
treatment that is only used sporadically."
American Sleep Apnea Association spokeswoman Christin
Englehardt says clinicians treating sleep apnea have been slow to recommend the
dental devices because there have been so few studies assessing their
effectiveness. But she adds that this may be changing.
"Oral appliance therapy is an accepted treatment for
obstructive sleep apnea, but as with any treatment option many factors may
determine its effectiveness, including the severity of the sleep disordered
breathing and the individual patient's medical history," she says.