Management of complications of oral appliance therapy for snoring and obstructive sleep apnea

코골이 및 폐쇄성 수면무호흡증의 구강내 장치 치료시 부작용 및 관리

  • Jo, Jung-Hwan (Department of Oral Medicine, Seoul National University Dental Hospital)
  • 조정환 (서울대학교치과병원 구강내과)
  • Published : 2019.04.30

Abstract

Oral appliances therapy is becoming increasingly recognized as a successful treatment for snoring and obstructive sleep apnea(OSA). Compared with continuous positive airway pressure(CPAP), the gold standard therapy for OSA, oral appliance therapy are less efficacious for severe OSA but are more acceptable and tolerable for patients, which in turn, may lead to a comparable level of therapeutic effectiveness. Nevertheless, the various side effects of oral appliance therapy, such as, increased salivation or dryness, pain or discomfort in the teeth or gums, occlusal discomfort in the morning, temporomandibular disorders, dental and occlusal changes may cause discontinuation of treatment or changes in treatment plan. Therefore, oral appliance therapy should be provided by a qualified dentist who can evaluate oral tissues, occlusion, and temporomandibular joints, and prevent and manage the possible side effects.

Keywords

References

  1. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Healh Study. JAMA 2002;283:1829-36. https://doi.org/10.1001/jama.283.14.1829
  2. Grunstein, RR. Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. Thorax 1995;50:1106-13. https://doi.org/10.1136/thx.50.10.1106
  3. Nino-Murcia G, McCann CC, Bliwise DL, et al. Compliance and side effects in sleep apnea patients treated with nasal continuous positive airway pressure. West J Med 1989;150:165-9.
  4. Chan AS, Lee RW, Cistulli PA. Dental appliance treatment for obstructive sleep apnea. Chest 2007;132:693-9. https://doi.org/10.1378/chest.06-2038
  5. Chan AS, Lee RW, Cistulli PA. Non-positive airway pressure modalites: mandibular advancement devices/positional therapy. Proc Am Thorac Soc 2008:5:179-84. https://doi.org/10.1513/pats.200707-104MG
  6. Padma A, Ramakrishnan N, Narayanan V. Management of obstructive sleep apnea: A dental perspective. Indan J Dent Res 2007;18:201-9. https://doi.org/10.4103/0970-9290.35833
  7. Almeida FR, Lowe AA, Tsuiki S, et al. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive seep apnea syndome. J Clin Sleep Med 2005;1:143-52. https://doi.org/10.5664/jcsm.8978
  8. Hoffstein V. Review of oral appliances for treatment of sleep disordered breathing. Sleep Breath 2007;11:1-22. https://doi.org/10.1007/s11325-006-0084-8
  9. Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 2006;29:244-62. https://doi.org/10.1093/sleep/29.2.244
  10. Giannasi LC, Almeida FR, Magini M, et al. Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluaticn. Sleep Bream 2009;13:375-81. https://doi.org/10.1007/s11325-009-0257-3
  11. Doff MH, Veldhuis SK, Hoekema A, et al. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. Clin Oral Investig 2012;16:689-97. https://doi.org/10.1007/s00784-011-0555-6
  12. Hammond RJ, Gotsopoulos H, Shen G, Petocz P, Cistulli PA, Darendeliler MA. A follow-up study of dental and skeleta changes associated with mandibular advancement splint use in obstructive sleep apnea. Am J Orthod Dentofac Orthop 2007;132(6):803-14.
  13. Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint in wear in patients who snore. Clin Otolaryngol 2005:3(2):149-56 https://doi.org/10.1111/j.1365-2273.2004.00944.x
  14. Almeida FR, Lowe AA, Surg JO, Tsuiki S, Otsuka R. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 1. cephalometric analysis. Am J Orthod Dentofac Orthop 2006;129:195-204. https://doi.org/10.1016/j.ajodo.2005.10.001
  15. Chen H, Lowe AA, de Almeida FR, Fleetham JA, Wang B. Three-dimensional computer-assisted study model analysis of long-term oral appliance wear. Part 2. Side effects of oral appliances. Am J Orthod Dentofacial Orthop 2008:134:408-17. https://doi.org/10.1016/j.ajodo.2006.10.031
  16. Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med 2014;10(12):1285-91. https://doi.org/10.5664/jcsm.4278
  17. Cohen-Levy J, Petelle B, Pinguet J, Limerat E, Fleury B. Forces created by mandibular advancement devices in OSAS patients. Sleep Breath 2013;17:781-9. https://doi.org/10.1007/s11325-012-0765-4
  18. Ueda H, Almeida FR, Lowe AA, Ruse NO. Changes in occlusal contact area during oral appliance therapy assessed on study models. Angle Orthod 2008;78:866-72. https://doi.org/10.2319/100107-470.1
  19. Gong X, Zhang J, Zhao Y, Gao X. Long-term therapeutic efficacy of oral appliances in treatment of obstructive sleep apnea-hypopnea syndrome. Angle Orthod 2013;83(4):653-8. https://doi.org/10.2319/060412-463.1
  20. Araie T, Okuno K, Minagi HO, Sakai T. Dental and skeletal changes associated with long-term oral appliance use for obstructive sleep apnea: a systematic review and meta-analysis. Sleep Med Rev 2018:41:161-72. https://doi.org/10.1016/j.smrv.2018.02.006
  21. Ghazal A, Jonas IE, Rose EC. Dental side effects of mandibular advancement appliances- a 2-year follow-up. J Orofac Orthop 2008;69:437-47. https://doi.org/10.1007/s00056-008-0811-9
  22. Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: part 2. study model analysis. Am J Orthod Dentofac Orthop 2006;129:205-13. https://doi.org/10.1016/j.ajodo.2005.04.034
  23. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofac Orthop 2006;129:214-21. https://doi.org/10.1016/j.ajodo.2005.10.004
  24. Minagi HO, Okuno K, Nohara K, Sakai T. Predictors of side effects with long-term oral appliance therapy for obstructive sleep apnea. J Clin Sleep Med 2018;14:119-25. https://doi.org/10.5664/jcsm.6896
  25. Ramar K, Dort LC, Katz SG, et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11:773-827. https://doi.org/10.5664/jcsm.4858
  26. 안홍균, 이광호, 정성창. 코골이와 폐쇄성수면무호흡증 환자에서 무호흡 심도에 따른 구강내 장치의 치료효과 및 환장의 적응도에 관한 연구. 대한구강내과학회지 1998:23:419-32.
  27. Schmidt-Nowara W, Lowe A, Wiegand L, et al. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501-10. https://doi.org/10.1093/sleep/18.6.501
  28. Okuno K, lkai K, Mastsumura-Ai E, Araie T. Titration technique using endoscopy for an oral appliance treatment of obstructive sleep apnea. J Prosthet Dent 2018;119:350-3. https://doi.org/10.1016/j.prosdent.2017.03.005
  29. Dieltjens M, Vanderveken OM, Heyning PH, Braem MJ. Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Med Rev 2012;16:177-85. https://doi.org/10.1016/j.smrv.2011.06.002
  30. Ishiyama H, Inukai S, Nishiyama A, et al. Effect of jaw-opening exercise on prevention of TMD pain associated with oral appliance therapy in OSA patients: A randomized, double-blind, placebo-controlled trial. J Prosthodont Res 2017;61:259-67. https://doi.org/10.1016/j.jpor.2016.12.001
  31. Cunali PA, Almeida RF, Santos CD, et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 2011;157:17-27.
  32. Sheat RD, Schell TG, Blanton AO, et al. Management of side effects of oral appliance therapy for sleep-disordered breathing. J Dent Sleep 2017:4:111-25. https://doi.org/10.15331/jdsm.6746