Hello, daiwa-ga!
Dental appliances appear to be a very viable alternative to surgery in
the treatment of sleep apnea. I have provided some resources for you
to look over so that you can make an informed choice about your
options.
==
The following article touches specifically on the success rate of
dental appliances versus surgery.
"SLEEP APNEA TREATMENT: ARE DENTAL APPLIANCES MORE SUCCESSFUL THAN
SURGERY?" by Ira Shapira. Sleep and Health. (April 2002)
http://www.sleepandhealth.com/Newspaper/2002/April/articles/10.htm
"While sleep medicine still considers CPAP/BiPAP to be the gold
standard of treatment for sleep apnea, low compliance rates (23-45%
based on several studies) have always been a problem. The alternatives
in treatment are lifestyle changes including weight loss and
positional training, surgery and dental appliances. The advantages of
surgical interventions have been that they require no patient
compliance after initial healing, though surgical morbidity is often
very high. Dental appliances on the other hand have high patient
compliance and minimal morbidity. The majority of patients continues
use and prefers them to CPAP/BiPAP."
** "A recent study in the journal Chest (chest. 220:121:739-746)
showed a higher success rate for dental sleep apnea appliances when
compared to Uvulopalatophayngoplasty (UP3) on mild to moderate apnea
patients who were followed up to four years. The success rate in the
dental appliance group was 81% compared to 53% in the UP3 group.
Success was defined as at least 50% reduction in the apnea index. A
more impressive figure was normalization or "cure" with 63% of the
dental appliance patients falling in this group with only 33% of UP3
patients falling in this group at the four-year follow-up. The
definition of a cure was an apnea index less than 5 or an
apnea/hypopnea index of less than 10. The dental appliance had 62%
compliance rate (much higher than CPAP) with minimal adverse side
effects. In the surgical group, 8% reported pronounced nasopharyngeal
regurgitation of fluid (food and fluid entering nasal cavity) and 10%
had significant swallowing problems."
"A previous article in Chest reported a 98% success rate with the TAP
appliance in treating snoring and high success in treating moderate to
severe apnea. The TAP appliance can be adjusted while the patient is
sleeping and this adjustability serves as a volume control for the
patient's significant other."
"It is vital that patients being treated with a dental appliance or
surgery have diagnostic polysomnography to evaluate efficacy for the
treatment and for appliance titration. With proper follow-up,
appliance therapy may one day be the gold standard of treatment if
compliance is considered into the equation."
==
Another study reveals similar success with mandibular appliances:
From " 4-Year follow-up of treatment with dental appliance or
uvulopalatopharyngoplasty in patients with obstructive sleep apnea."
Walker-Engstrom ML, et al. Chest March 2002; 121:739-46.
http://www.findarticles.com/cf_dls/m3225/12_65/87721438/p1/article.jhtml
An excerpt:
"The success rate for the mandibular advancement device was
significantly better than the rate for UPPP. At four years, 63 percent
of patients using the mandibular device achieved normalization of the
apnea index, while only 33 percent of those who underwent UPPP had
normalization of the apnea index. Compliance with the mandibular
device was 62 percent at four years. Complication rates for UPPP were
approximately 10 percent."
"The authors conclude that the mandibular advancement device had
significantly higher success and normalization rates than UPPP
surgery. The success rate was compromised by the fact that the
compliance rate with the mandibular advancement device was 62 percent.
However, the authors state that the mandibular advancement device
should be recommended for long-term treatment of patients with mild to
moderate sleep apnea."
==
An overview of the above study is also found in the following article:
"Dental appliance beats surgery for sleep apnea."
http://www.healthmantra.com/ypb/jan2002/osa.htm
"A dental appliance worn at night appears to be more successful in
treating obstructive sleep apnea (OSA) than surgery, according to a
study conducted in Sweden."
"People with OSA stop breathing dozens of times each night, causing
them to gasp for breath. The condition is conservatively estimated to
affect up to 4% of middle-aged Americans, and is particularly common
among obese people. Sleep apnea has been linked to daytime sleepiness,
as well as an increased risk of high blood pressure and cardiovascular
disease."
"The Swedish study found the success rate in patients with OSA who
wore the dental appliance was 81%, compared to 53% in OSA patients who
had surgery. However, after 4 years, many patients were no longer
wearing the device when they slept. Lead author Dr. Marie-Louise
Walker-Engstrom of Central Hospital in Vasteras, Sweden, and
colleagues report their findings in the March issue of the medical
journal Chest."
Read more...
==
The following articles about mandibular devices are more extensive but
show good results:
"Mandibular Advancement Device in Patients With Obstructive Sleep
Apnea(*): Long-term Effects on Apnea and Sleep," by Marie Marklund,
Carin Sahlin, Hans Stenlund, Maurits Persson, Karl A. Franklin. Chest,
(July, 2001)
http://www.findarticles.com/cf_dls/m0984/1_120/76994060/p1/article.jhtml
"Evaluation of Variable Mandibular Advancement Appliance for Treatment
of Snoring and Sleep Apnea(*)" by Jeffrey Pancer, Salem Al-Faifi,
Mohamed Al-Faifi, Victor Hoffstein. Chest, (Dec, 1999)
http://www.findarticles.com/cf_dls/m0984/6_116/58614499/p1/article.jhtml
==
The following two articles addresses some of the aspects to consider
with oral appliances:
"Cutting-edge Issues in Dental Sleep Medicine," by Kent Moore, DDS,
MD. American Sleep Apnea Association. (Sept. 2002)
http://www.sleepapnea.org/dentalsleep.html
"Snoring and Obstructive Sleep Apnea, Prosthetic Management," by John
M Truelson, MD, FACS. eMedicine (Last Updated: April 15, 2002)
http://www.emedicine.com/ent/topic498.htm
==
You might also be interested in the following forum discussions about
dental appliances:
"Re: mathematics of sleep apnea." Sleepnet.com (March 03, 1998)
http://www.sleepnet.com/forum3/messages/445.html
"Dental Appliance Experience."
http://www.sleepquest.com/cgibin/forum/SleepApnea/messages/596.html
==
I hope these articles help you to make an informed decision about
which option will be the best choice for you!
Sincerely,
umiat-ga
Google Search Strategy
dental appliance for sleep apnea +success |
