oral appliances and apnea and cardiac disease

Oral appliances, such as a mandibular advancement device
and tongue-retaining devices, work by mechanically enlarging
the upper airway by displacing the tongue forward and reducing its collapsibility during sleep,
41
mimicking the Jaw-
Thrust technique used by anesthesiologists to open the
airway in sedated patients. Both the mandibular advancement
device and tongue-retaining devices increase cross-sectional
area of the airway at the level of the velopharynx and
oropharynx, although the change in diameter is greater with
tongue-retaining devices than with the mandibular advance-
ment device.
42
Oral appliances are effective in reducing AHI in
patients with OSA
43
but are less ef
fi
cacious than PAP
therapy.
41,43
Baseline AHI
≥
30 and maximum therapeutic
CPAP pressure
>
12 mm Hg are predictive of oral appliance
treatment failure (success de
fi
ned by achieving either AHI
< 5, or 5 ≤ AHI < 10 with >
50% reduction from baseline), and thus
these clinical features should be considered when selecting
patients for oral appliance therapy.
44
Oral appliances are
recommended for treatment of primary snoring without OSA,
and in mild-to-moderate OSA in cases where the patient
strongly prefers to try an appliance over PAP therapy. They
are also preferable compared with no therapy for primary
snoring without OSA, or OSA of any severity in patients who
are intolerant to or unwilling to try PAP therapy.