tailieunhanh - Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review

To our Fellows, Friends and Supporters: NYAM is pleased to present our 2010 Annual Report to share our accomplishments in policy, research, community engagement and education in 2010. For more than 160 years, NYAM has been a vital source for effective and innovative thought and action regarding health problems that affect New York City, in particular, and cities in general. Now, more than ever, NYAM is committed to developing interdisciplinary approaches to addressing pressing urban health issues and making New York a healthy place for people of all ages to live, work, learn, and play. . | REVIEW Oral Appliances for Snoring and Obstructive Sleep Apnea A Review Kathleen A. Ferguson MD1 Rosalind Cartwright PhD2 Robert Rogers DMD3 Wolfgang Schmidt-Nowara MD4 Division of Respirology University of Western Ontario London Ontario Canada Department of Behavioral Sciences Rush University Medical Center Chicago IL Department of Dental Medicine St. Barnabas Medical Center Gibsonia PA University of Texas Southwestern Sleep Medicine Associates of Texas Dallas TX Abstract We conducted an evidence-based review of literature regarding use of oral appliances OAs in the treatment of snoring and obstructive sleep apnea syndrome OSA from 1995 until the present. Our structured search revealed 141 articles for systematic scrutiny of which 87 were suitable for inclusion in the evidence base including 15 Level I to II randomized controlled trials and 5 of these trials with placebo-controlled treatment. The efficacy of OAs was established for controlling OSA in some but not all patients with success defined as no more than 10 apneas or hypopneas per hour of sleep achieved in an average of 52 of treated patients. Effects on sleepiness and quality of life were also demonstrated but improvements in other neurocognitive outcomes were not consistent. The mechanism of OA therapy is related to opening of the upper airway as demonstrated by imaging and physiologic monitoring. Treatment adherence is variable with patients reporting using the appliance a median of 77 of nights at 1 year. Minor adverse effects were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use but the long-term dental significance of this is uncertain. In comparison to continuous positive airway pressure CPAP OAs are less efficacious in reducing the apnea hypopnea index AHI but OAs appear to be used more at least by self report and in many studies were preferred over CPAP when the treatments were compared. OAs

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