Oral Appliances Come Of Age...
Over the years, we have watched Oral Appliances earn their stripes.
1980’s First appeared in the literature
1995 AASM Clinical Guidelines: First Line for Snoring & Mild Sleep Apnea. (SLEEP, Vol. 18, 1995)
2006 AASM Clinical Guidelines revised to Include Moderate Sleep Apnea. (SLEEP, Vol. 29, 2006)
2013 OA vs CPAP: “health outcomes in patients with moderate to severe OSA were similar after treatment…likely explained by the greater efficacy of CPAP being offset by inferior compliance” . (Am J Respir Crit Care Med Vol. 187(8) 2013)
2014 Review Article: “ strong evidence base demonstrating OA improve OSA in the majority of patients, including some with more severe disease. However, OA are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit” … “Establishing best quality devices that are objectively validated in terms of both efficacy and durability in combination with recent advances in patient selection and treatment monitoring, will continue to optimize OA as an effective and even first-line treatment for OSA.” (J Clin Sleep Med Vol. 10(2) 2014)
This Milestone Review Article, carried out by leading investigators and sponsored by the Oral Appliance Network on Global Effectiveness (ORANGE Registry), indicates that Oral Appliance Therapy has reached a pivotal point. However, there is more work to do. The article discusses the need to discriminate responders from non-responders and reference is made to the commercially available MATRx, which enables a sleep laboratory to predict a patient’s target protrusive position from the control room, during an attended sleep study using a remote control device without disturbing the patient’s sleep. The article also discusses the use of built-in compliance monitors that provide objective data on patient usage, stating that these monitors may help improve patient management of OSA and provide essential data for patients, dentists and physicians.
These are very exciting times for those of us that provide Oral Appliance Therapy. Compliance monitors have come a long way since first introduced and will help demonstrate patient compliance to therapy for those patients required to do so. With the now commercially available MATRx, we can not only establish candidacy prior to making an appliance but also establish the optimum jaw posture during an in-lab sleep study. Perhaps the day will come when split-night sleep studies are routinely performed; evaluating optimum CPAP settings, optimum Oral Appliance settings and verifying Response to Therapy, all during one Sleep Study. Who would of thought...