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Oral Appliance Therapy for OSA

Physician-dentist collaboration supports oral appliance therapy for patients with OSA.

Healthcare professionals understand that patients who can't tolerate their therapies quickly abandon them, leaving them vulnerable to adverse health effects. Continuous positive airway pressure (CPAP) therapy remains the gold standard for the treatment of obstructive sleep apnea (OSA), but studies demonstrate that half of patients become non-adherent after one year.1

By understanding the research behind dental sleep medicine and the best practices of a successful physician-dentist collaboration, sleep physicians can leverage oral appliance therapy to help their non-adherent patients move from being untreated to improving OSA symptoms in a few short months.

"Interdisciplinary collaboration provides the best avenue for treatment when a patient is non-adherent with CPAP," said Harold A. Smith, DDS, president of the American Academy of Dental Sleep Medicine (AADSM). "The AADSM wants to help dentists and physicians work together to optimally treat adults who have OSA."

Clinical Support for Oral Appliance Therapy

There has been methodical and results-driven growth of the dental sleep medicine field over the past 25 years. A wealth of published research supports the effectiveness of oral appliance therapy, the development of professional associations and the establishment of recognized continuing education and credentials.

SEE ALSO: Economic & Social Costs of Sleep Apnea

In alignment with this growth, the Clinical Practice Guideline for Oral Appliance Therapy published jointly in 2015 by the American Academy of Sleep Medicine (AASM) and the AADSM officially recommends sleep physicians consider prescription of oral appliances for adult patients with OSA who are intolerant of CPAP therapy or prefer alternate therapy.2

"The first AADSM and AASM joint Clinical Guideline is a testament to the importance of dentist-physician relationships in treating OSA with oral appliance therapy, and it provides a framework for ensuring the best outcomes for patients who are prescribed a custom-fitted oral appliance," said Smith.

According to the Clinical Guideline, meta-analyses show CPAP is superior to oral appliance therapy in improving apnea hypopnea index (AHI) and lowering both the arousal index and the oxygen desaturation index (ODI), but the efficacy gap can be closed when adherence is taken into consideration.

Clinical Measures

Among patients who begin CPAP therapy, it is estimated that only 50% continue with long-term treatment.3 In contrast, 76% of patients report using their oral appliance after one year, and 62% of patients after four years.4 Research further suggests patients use CPAP on average between three and five hours per night,5 while oral appliances have been found, through objective adherence monitoring, to be used a mean of 6.7 hours per night6.

Together these scientific studies suggest that the treatment adherence rate for oral appliance therapy is greater than CPAP and, therefore, its overall therapeutic effectiveness may be comparable7. "For patients with OSA who do not adhere to CPAP, an oral appliance has proven to be a viable option," Smith stated.

Oral appliance therapy also is proven to be similar to CPAP in its effect on several clinical measures. In addition to reducing snoring and severity of sleep-disordered breathing, oral appliances can reduce blood pressure, cardiovascular mortality and subjective daytime sleepiness, and they can improve quality of life and neurobehavioral functioning.8-11

Best Practices

When a sleep physician and dentist work collaboratively, the evidence-based Clinical Guideline provides best practices to help ensure successful outcomes. The following recommendations take into account the knowledge, skill and licensure of each profession for the ultimate benefit of the patient:

  • OSA is best diagnosed by a sleep physician who is either board-certified or board-eligible in sleep medicine.
  • Once a patient is diagnosed with OSA by a board-certified sleep physician, a dentist trained in dental sleep medicine can provide treatment with oral appliance therapy.
  • When oral appliance therapy is prescribed by a physician, the dentist should use a custom, titratable oral appliance instead of a non-custom oral device.
  • Dentists should provide oversight - rather than no follow-up - of oral appliance therapy to survey for dental-related side effects or occlusal changes and reduce their incidence.
  • Sleep physicians should conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing.
  • Periodic visits with both the sleep physician and dentist are recommended for adult patients treated with oral appliance therapy for OSA.

Mutual Understanding

As the only nonprofit, professional organization dedicated exclusively to the practice of dental sleep medicine, the AADSM is recognized by the AASM as the leading national organization for dentists who provide oral appliance therapy. The 3,000 AADSM members have access to exclusive educational resources and practice management support that help them excel in dental sleep medicine.

"The success of oral appliance therapy is reliant upon the support of the medical team and its dedication to best practices that have been honed by years of research," said Smith. Now serving in his second term as AADSM President, he intends to "continue to promote the importance of evidence-based standards of practice and dentist-physician collaboration in the treatment of sleep apnea."

Content provided by AADSM.

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