Intraoral Appliance Therapy - A Better Alternative for Apnea Than CPAP?

Authors

Bryan Teigman

Abstract

Obstructive sleep apnea (OSA) is a condition where there is a physiologic hindrance of airflow to the lungs, triggering the brain to interfere with the sleep cycle and awaken an individual to provide sufficient oxygen flow. For years, the continuous positive airway pressure (CPAP) machine has been the gold standard of care for patients suffering from OSA. Nonetheless, the machine has its flaws of being bulky, noisy, and other side effects, causing a low adherence rate and thus a lower relief rate of OSA symptoms. Accordingly, there have been many researchers seeking a more effective way to treat OSA, such as intraoral devices that manipulate the jaw and tongue placement to prevent pharyngeal airway collapse. The purpose of this paper is to compare the efficacy of continuous positive airway pressure (CPAP) and intraoral devices in the treatment of obstructive sleep apnea (OSA) based on the available evidence from original studies. To diagnose OSA, the studies used the Epworth sleepiness scale (ESS), the apnea hypopnea index (AHI), polysomnography (PSG), and the respiratory disturbance index (RDI). All studies found that, when adhered to properly, CPAP is more efficient in reducing OSA symptoms such as excessive daytime sleepiness, nighttime arousals, and hypertension, especially in more severe cases. Nonetheless, these studies also found CPAP to have lower adherence rates when compared to intraoral devices, influencing the effectiveness of the treatment. Furthermore, it was found that the margin for treatment relief between CPAP and intraoral devices decreased with a decline in OSA severity. This can be explained due to the fact that less severe cases do not require as rigorous treatment to control by symptoms. Accordingly, treatment planning needs to be individualized according to severity and expected adherence of each patient. In patients with mild-to-moderate OSA, intraoral devices seem to provide adequate relief of symptoms, while boasting a much higher adherence rate. Furthermore, in patients with severe sleep apnea, CPAP treatment continues to prove superior results. However, in patients who do not use the machine properly, intraoral devices may be considered.

Recommended Citation

Bryan Teigman. (2023). Intraoral Appliance Therapy - A Better Alternative for Apnea Than CPAP?. The Science Journal of the Lander College of Arts and Sciences, 16(2), 65-70. Retrieved from https://touroscholar.touro.edu/sjlcas/vol16/iss2/11