Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterized by repeated episodes of complete or partial obstruction of the upper airway. OSAS has a frequency of 4 percent and is classified according to the number of obstructive sleep apnea-hypopnea episodes. The OSAS diagnostic path starts with the evaluation of the patient’s clinical framework and follows an instrumental procedure, depending on the clinical severity of the patient. Dental practitioners have the ability to intercept early on the signs and symptoms of OSAS. At the same time, they can assess whether the patient has the indications for treatment with specific oral devices (Oral Appliances, OA). The purpose of this paper is to provide guidance for dental management of obstructive sleep apnea syndrome in adult individuals.
References
[1]
Mbata, G.C. and Chukwuka, J.C. (2012) Obstructive Sleep Apnea Hypopnea Syndrome. Annals of Medical & Health Sciences Research, 2, 74-77.
[2]
Lee, W.H., Wee, J.H., Lee, C.H., Kim, M.S., Rhee, C.S., Yun, P.Y., Yoon, I.Y. and Kim, J.W. (2013) Comparison between Mono-Bloc and Bi-Bloc Mandibular Advancement Devices for Obstructive Sleep Apnea. European Archives of Oto-Rhino-Laryngology, 270, 2909-2913. https://doi.org/10.1007/s00405-013-2417-0
[3]
Gagnadoux, F., Fleury, B., Vieille, B., Meslier, N., N’Guyen, X.L., Trzepizur, W. and Racineux, J.L. (2009) Titrated Mandibular Advancement versus Positive Airway Pressure for Sleep Apnea. European Respiratory Journal, 34, 914-920.
https://doi.org/10.1183/09031936.00148208
[4]
Randerath, W.J., Verbraecken, J., Andreas, S., Bettega, G., Boudewyns, A., Hamans, E., Jalbert, F., Paoli, J.R., Sanner, B., Smith, I., Stuck, B.A., Lacassagne, L., Marklund, M., Maurer, J.T., Pepin, J.L., Valipour, A., Verse, T. and Fietze, I. (2011) European Respiratory Society Task Force on Non-CPAP Therapies in Sleep Apnea. Non-CPAP Therapies in Obstructive Sleep Apnea. European Respiratory Journal, 37, 1000-1028. https://doi.org/10.1183/09031936.00099710
[5]
Cistulli, P.A., Gotsopoulos, H., Marklund, M. and Lowe, A.A. (2004) Treatment of Snoring and Obstructive Sleep Apnea with Mandibular Repositioning Appliances. Sleep Medicine Reviews, 8, 443-457. https://doi.org/10.1016/j.smrv.2004.04.002
[6]
Deane, S.A., Cistulli, P.A., Ng, A.T., Zeng, B., Petocz, P. and Darendeliler, M.A. (2009) Comparison of Mandibular Advancement Splint and Tongue Stabilizing Device in Obstructive Sleep Apnea: A Randomized Controlled Trial. Sleep, 32, 648-653. https://doi.org/10.1093/sleep/32.5.648
[7]
Stradling, J. and Dookun, R. (2009) Snoring and the Role of the GDP: British Society of Dental Sleep Medicine (BSDSM) Pre-Treatment Protocol. British Dental Journal, 206, 307-312. https://doi.org/10.1038/sj.bdj.2009.214
[8]
National Guidelines for Prevention and Odontoiatric Treatment of Obstructive Sleep Apnea Syndrome (OSAS). Ministry of Health, General Directorate for Health Prevention, Italy, 2014.
[9]
Sil, A., Barr, G., Marin, J.M., Agusti, A., Villar, I., Forner, M., Nieto, D., Carrizo, S.J., Barbé, F., Vicente, E., Wei, Y., Nieto, F.J. and Jelic, S. (2012) Assessment of Predictive Ability of Epworth Scoring in Screening of Patients with Sleep Apnea. The Journal of Laryngology & Otology, 126, 372-379.
https://doi.org/10.1017/S0022215111003082
[10]
Dort, L. and Brant, R. (2008) A Randomized, Controlled, Crossover Study of a No Customized Tongue Retaining Device for Sleep Disordered Breathing. Sleep and Breathing, 4, 369-373. https://doi.org/10.1007/s11325-008-0187-5
[11]
Epstein, L.J., Kristo, D., Strollo Jr., P.J., Friedman, N., Malhotra, A., Patil, S.P., Ramar, K., Rogers, R., Schwab, R.J., Weaver, E.M. and Weinstein, M.D. (2009) Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical Guideline for the Evaluation, Management and Long-Term Care of Obstructive Sleep Apnea in Adults. Journal of Clinical Sleep Medicine, 5, 263-276.
[12]
Ferguson, K.A., Cartwright, R., Rogers, R. and Schmidt-Nowara, W. (2006) Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review. Sleep, 29, 244-262.
https://doi.org/10.1093/sleep/29.2.244
[13]
Chan, A.S. and Cistulli, P.A. (2009) Oral Appliance Treatment of Obstructive Sleep Apnea: An Update. Current Opinion in Pulmonary Medicine, 15, 591-596.
https://doi.org/10.1097/MCP.0b013e3283319b12
[14]
Giannasi, L.C., Almeida, F.R., Nacif, S.R. and de Oliveira, L.V. (2013) Efficacy of an Oral Appliance for the Treatment of Obstructive Sleep Apnea. The International Journal of Prosthodontics, 26, 334-339. https://doi.org/10.11607/ijp.3284
[15]
Hoekema, A., Stegenga, B., Wijkstra, P.J., Van der Hoeven, J.H., Meinesz, A.F. and de Bont, L.G.M. (2008) Obstructive Sleep Apnea Therapy. Journal of Dental Research, 87, 882-887. https://doi.org/10.1177/154405910808700917
[16]
Hoffstein, V. (2007) Review of Oral Appliances for Treatment of Sleep-Disordered Breathing. Sleep and Breathing, 11, 1-22.
https://doi.org/10.1007/s11325-006-0084-8
[17]
Holley, A.B., Lettieri, C.J. and Shah, A. (2011) Efficacy of an Adjustable Oral Appliance and Comparison with Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome. Chest, 140, 1511-1516.
https://doi.org/10.1378/chest.10-2851
[18]
Kreivi, H.R., Virkkula, P., Lehto, J.T. and Brander, P.E. (2012) Upper Airway Symptoms in Primary Snoring and in Sleep Apnea. Acta Oto-Laryngologica, 132, 510-518.
https://doi.org/10.3109/00016489.2011.644803
[19]
Friedman, M., Hamilton, C., Samuelson, C.G., Kelley, K., Pearson-Chauhan, K., Taylor, D., Taylor, R., Maley, A. and Hirsch, M.A. (2012) Compliance and Efficacy of Treatable Thermoplastic versus Custom Mandibular Advancement Devices. Otolaryngology—Head and Neck Surgery, 147, 379-386.
https://doi.org/10.1177/0194599812439683
[20]
Kushida, C.A., Morgenthaler, T.I., Littner, M.R., Alessi, C.A., Bailey, D., Coleman Jr., J, Friedman, L., Hirshkowitz, M., Kapen, S., Kramer, M., Lee-Chiong, T., Owens, J. and Pancer, J.P. (2006) An American Academy of Sleep Medicine Report. Practice parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005. Sleep, 29, 240-243.
https://doi.org/10.1093/sleep/29.2.240
[21]
Andrèn, A., Sjoquist, M. and Tegelberg, A. (2009) Effects on Blood Pressure after Treatment of Obstructive Sleep Apnea with a Mandibular Advancement Appliance—A Three-Year Follow-Up. Journal of Oral Rehabilitation, 36, 719-725.
https://doi.org/10.1111/j.1365-2842.2009.01987.x
[22]
Lim, J., Lasserson, T.J., Fleetham, J. and Wright, J. (2006) Oral Appliances for Obstructive Sleep Apnea. The Cochrane Database of Systematic Reviews, 25, CD0044 35.
[23]
Dieltjens, M., Vanderveken, O.M., Hamans, E., Verbraecken, J.A., Wouters, K., Willemen, M., De Backer, W.A., Van de Heyning, P.H. and Braem, M.J. (2013) Treatment of Obstructive Sleep Apnea Using a Custom-Made Treatable Duo Bloc Oral Appliance: A Prospective Clinical Study. Sleep and Breathing, 17, 565-572.
https://doi.org/10.1007/s11325-012-0721-3
[24]
Lettieri, C.J., Paolino, N., Eliasson, A.H., Shah, A.A. and Holley, A.B. (2011) Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 7, 439-445.
https://doi.org/10.5664/jcsm.1300
[25]
Vanderveken, O.M., Devolder, A., Marklund, M., Boudewyns, A.N., Braem, M.J., Okkerse, W., Verbraecken, J.A., Franklin, K.A., De Backer, W.A. and Van de Heyning, P.H. (2008) Comparison of a Custom-Made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 178, 197-202.
https://doi.org/10.1164/rccm.200701-114OC
[26]
Woodson, B.T., Steward, D.L., Mickelson, S., Huntley, T. and Goldberg, A. (2010) Multicenter Study of a Novel Adjustable Tongue-Advancement Device for Obstructive Sleep Apnea. Otolaryngology—Head and Neck Surgery, 143, 585-590.
https://doi.org/10.1016/j.otohns.2010.06.902
