Oral Appliances and Surgical Techniques for Treatment of Obstructive Sleep Apnea Syndrome

Abstract

Oral appliances (OAs) are widely used for the treatment of obstructive sleep apnea syndrome (OSAS), both as primary therapy and as an alternative for patients who are unwilling or unable to tolerate continuous positive airway pressure (CPAP). There are a large number of different OAs available which increase the size of the upper airway by either advancing the mandible or the tongue. There is increasing evidence that OAs improve daytime sleepiness, systemic hypertension, and indices of sleep-disordered breathing in patients with OSAS. A variety of predictors of OA treatment success have been proposed but require prospective validation. Self-reported treatment adherence varies between OA types and decreases with duration of use. OA side effects are common, but generally minor. The cost of OA therapy varies depending on the type of OA used and the extent and expertise of the dental supervision. There is increasing evidence that OA is a cost-effective treatment for OSAS. Upper airway surgery is the treatment of choice in the small number of patients with OSAS who have a specific anatomic upper airway lesion. A variety of upper airway surgical procedures have been developed for the treatment of OSAS. The goal of these procedures is to increase upper airway size or decrease upper airway collapsibility by (1) resection of redundant soft tissue (nasal surgery, uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty (LAUP), midline glossectomy); (2) induction of scar tissue formation (cautery or radio frequency ablation of soft palate, tongue, or epiglottis); or (3) displacement of bony and ligamentous attachments of upper airway soft tissue structures (maxillary and mandibular osteotomies, tongue and hyoid suspensions). The efficacy of upper airway surgery for OSAS is not as well established as CPAP or OA, so long-term follow-up is strongly recommended.