title: Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  This study, by means of a mail survey, quantified the compliance with and side effects of the use of an oral appliance for more than five years in patients with snoring or obstructive sleep apnea.
  
  
  METHODS
  A questionnaire was mailed to 544 patients who used an oral appliance for the treatment of snoring or obstructive sleep apnea.
  
  
  RESULTS
  Some 46.1% of the patients returned the questionnaire, 37.8% did not, 15% had an invalid address, and 0.9% were deceased. The mean time period between oral appliance insertion and the return date of these surveys was 5.7 +/- 3.5 years. Of the returned sample, 64.1% were wearing their oral appliance (users). There was no significant difference in the baseline and post-titration respiratory disturbance index between the returned and not-returned groups or between patients who had stopped wearing the oral appliance (nonusers) and users. Within the users group, 93.7% used the oral appliance more than 4 nights per week, 100% wore it more than half of each night, and 95% were satisfied with the treatment. The most frequent reasons why patients discontinued wear were uncomfortable (44.4%), had little or no effect (33.6%), or switched to nasal continuous positive airway pressure (23.3%). Snoring was satisfactorily controlled in 75.6% of users and in 43.2% of nonusers. Side effects, such as dry mouth and tooth and/or jaw discomfort, were more frequent and more severe in the nonusers (P < .05). With oral appliance usage, both users and nonusers reported an increase in temporomandibular joint symptoms, but there was no difference in the degree of change.
  
  
  CONCLUSIONS
  Subjects who were compliant with oral appliance therapy reported long periods of use and adequate control of snoring.
authors.affiliation: Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada. falmeida@interchange.ubc.ca
authors.forename: Fernanda Ribeiro
authors.initials: FR
authors.lastname: de Almeida
authors.forename: Alan A
authors.initials: AA
authors.lastname: Lowe
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuiki
authors.forename: Ryo
authors.initials: R
authors.lastname: Otsuka
authors.forename: Mary
authors.initials: M
authors.lastname: Wong
authors.forename: Sandra
authors.initials: S
authors.lastname: Fastlicht
authors.forename: Frank
authors.initials: F
authors.lastname: Ryan
mesh_terms: D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009968:Orthodontic Appliances, Removable / Q000009:adverse effects*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000628:therapy*; D012913:Snoring / Q000209:etiology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome