Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005.
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.
Kushida
Clete A
CA
Stanford University Center of Excellence for Sleep Disorders, CA, USA.
Morgenthaler
Timothy I
TI
Littner
Michael R
MR
Alessi
Cathy A
CA
Bailey
Dennis
D
Coleman
Jack
J
Friedman
Leah
L
Hirshkowitz
Max
M
Kapen
Sheldon
S
Kramer
Milton
M
Lee-Chiong
Teofilo
T
Owens
Judith
J
Pancer
Jeffrey P
JP
D045422:Continuous Positive Airway Pressure / Q000295:instrumentation*; D004867:Equipment Design; D006801:Humans; D009968:Orthodontic Appliances, Removable; D017286:Polysomnography; D017755:Prosthesis Fitting; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D012913:Snoring / Q000453:epidemiology* / Q000628:therapy*