CHEST Guidelines-Oral-Appliances-and-Sleep-Disordered-Breathing

Oral-Appliances-and-Sleep-Disordered-Breathing_che

Pdf Summary

The document discusses recent studies and data on the effectiveness and challenges related to oral appliance therapy for treating obstructive sleep apnea (OSA). Oral appliances are generally used for mild to moderate OSA but face issues with insurance coverage and physician hesitancy due to a lack of long-term efficacy data. Studies like those by Vezina et al. and Gauthier et al. have assessed the long-term risks and effectiveness of different oral appliances, though participation rates in follow-ups are low. These studies indicate that while appliances can be effective in reducing apnea-hypopnea index (AHI), patients experience initial pain and the process of selecting the right device could be improved with proper guidelines.<br /><br />The document also touches on surgical options for OSA, suggesting that oral appliances could be as effective as certain surgeries with fewer risks. It emphasizes the need for further long-term research to better understand the impact and to improve appliance selection strategies.<br /><br />Moreover, it discusses potential benefits of allowing patients to try multiple appliances before deciding, as this could improve satisfaction and compliance despite higher costs. The text suggests that oral appliances could be a cost-effective, long-term solution for OSA if insurance companies and health systems are convinced with supporting data.<br /><br />Lastly, there's an implied shift in medical practice from monobloc to bibloc devices to minimize complications and enhance effectiveness. There's a call for more standardized guidelines for selecting oral devices, tailored to patient-specific factors like gender, dentition, and severity of OSA. The comprehensive evaluation stated emphasizes the complex decision-making process involving oral devices, surgery, and continuous positive airway pressure (CPAP) therapy in managing sleep-disordered breathing.

Keywords

oral appliance therapy

obstructive sleep apnea

insurance coverage

long-term efficacy

apnea-hypopnea index

surgical options

patient satisfaction

monobloc vs bibloc

standardized guidelines

CPAP therapy