Treatment Options

Oral Appliances for Treatment of Mild to Moderate Obstructive Sleep Apnea (OSA)

Moderate Value

Obstructive sleep apnea (OSA) is caused by a blockage of the airway during sleep. The feeling of choking is usually responsible for waking the person so they can begin breathing again. This results in poor quality of sleep.

Oral appliances are a recommended treatment for people who have not responded to lifestyle changes. Oral appliance therapy involves the use of an appliance that repositions the lower jaw and tongue. These appliances can vary in design, but they all have the same purpose: to assist in maintaining an open airway for a person while they sleep.

Things to Consider

  • OSA is linked to obesity.
  • OSA is more common in people older than 40 years of age. In the 65-years-and-older age group, it is more common in men.
  • The main symptom of obstructive sleep apnea (OSA) is heavy snoring.
  • Other signs and symptoms that may suggest significant risk for OSA:
    • Brief interruptions of breathing (sleep apnea) during sleep reported by sleep partner
    • Awakened by choking
    • Severe daytime sleepiness, especially with driving impairment
    • Large neck
    • High blood pressure
  • OSA is confirmed through a polysomnogram performed in a sleep laboratory.   A polysomnography is a test that records a variety of body functions that occur during sleep.  These body functions include: the electrical activity of the brain, eye movement, muscle activity, heart rate, respiratory effort, airflow, and blood oxygen levels.  These tests are used both to diagnose sleep apnea and to determine its severity.

Results

Moderate Value

Will I live longer if I use this treatment?

Scientific evidence does not show that using oral appliances for the treatment of OSA prolongs life.

Will oral appliances when used to treat OSA improve my quality of life?

Quality of life can be improved. Some of the things that untreated obstructive sleep apnea can cause are:

  • Harmful effects on the cardiovascular system
  • Memory problems
  • Weight gain
  • Impotence
  • Headaches
  • Poor job performance

Will oral appliances improve my symptoms?

Patients wear the oral appliance at night during sleep. The use of the device may improve symptoms, but will not result in a cure of the problem.  The treatment must be continued indefinitely.

Safety

Moderate Value

There have been reported complications.

Reported adverse events include the following:

  • Temporomandibular (TMJ) pain (jaw pain)
  • Dental occlusion (poor alignment of teeth)
  • Poor function of the temporomandibular joint (jaw area)
  • Receding gums and/or tooth loss

Comparison

Moderate Value

Alternative treatments include:

  • For people with mild sleep apnea, some lifestyle changes include:
    • Eliminating evening alcohol and sedatives
    • Losing weight
    • Avoid sleeping on your back
  • Non-surgical alternatives for people who do not respond to lifestyle changes include:
    • Continuous positive airway pressure (CPAP), which is considered the standard of care for the treatment of OSA.  CPAP includes wearing a mask or nasal prongs connected to an air pump over the nose (or nose and mouth) during sleep.
    • Oral appliances are usually a good alternative for people who cannot tolerate CPAP. 
  • Some of the invasive surgical alternatives for people who do not respond to conservative treatment include:
    • Uvulopalatopharyngoplasty (UPPP), which is tightening of the soft tissue and removal of the uvula located in the back of the throat.
    • Tonsillectomy
    • Surgically moving the tongue or jaw
    • Tracheostomy, which is a surgical opening through the neck, into the windpipe. (Reserved for extreme cases when all other treatments have failed)

Cost

Moderate Value

The average cost for an oral appliance for the management of mild to moderate obstructive sleep apnea may range from $100 to $1,200 with an average cost of $826 depending on the specific oral appliance used.

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

National Guideline Clearinghouse. Management of obstructive sleep apnoea/hypopnoea syndrome in adults. A national clinical guideline.  Retrieved January 9, 2014 from http://guideline.gov/content.aspx?id=3878#Section420.  

MayoClinic.com. (2013, June). Obstructive sleep apnea. Retrieved January 9, 2014 from http://www.mayoclinic.com/health/obstructive-sleep-apnea/DS00968.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  moderate value

safety:  moderate value

comparison:  moderate value

cost: moderate value


total: moderate value

legend

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Page modified:January 31, 2014