Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005

TLDR

These updated practice parameters revise earlier recommendations on using oral appliances for snoring and OSA, noting that CPAP remains the preferred treatment for severe OSA until stronger evidence supports oral appliance efficacy. The parameters highlight the need for research to better define patient characteristics that predict oral appliance acceptance, success, and adherence. Oral appliances are indicated for mild‑to‑moderate OSA patients who prefer them or are unsuitable for CPAP, should be fitted by trained dental specialists, and require follow‑up polysomnography or Type 3 studies plus regular dental visits to monitor efficacy, adherence, device integrity, oral health, and signs of OSA worsening.

Abstract

These practice parameters are an update of the previously published recommendations regarding use of oral appliances in the treatment of snoring and Obstructive Sleep Apnea (OSA). Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. Research to define patient characteristics more clearly for OA acceptance, success, and adherence is needed.