Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes.
OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes. Recent comparative effectiveness trials have shown health outcomes between CPAP and OAm treatments are equivalent, even in severe OSA, despite greater efficacy of CPAP in reducing AHI. This likely reflects greater nightly adherence to OAm compared to CPAP therapy. Recent advances in technologies related to OAm treatment have the potential to further improve their efficacy and effectiveness in clinical practice. Selection of appropriate patients who will respond to OAm treatment is an ongoing barrier to use.
The now commercially available remotely controlled mandibular positioner offers a means to predict response from a single-night mandibular titration study and has shown good positive predictive value in initial testing. The advent of new adherence monitoring technology that can be routinely incorporated into OAm devices to objectively monitor treatment usage represents another advance in OSA treatment, which will be beneficial in practice and research. This will further help clarify the role of OAm in OSA treatment next to CPAP. 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 OAm as an effective and even first-line treatment for OSA.
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