Below is a summary of the most recent guidelines from the American Academy of Sleep
Medicine, the Academy that all sleep doctors belong to, showing that oral appliances should be the standard for use in treatment of sleep apnea.
Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015
Kannan Ramar, MBBS, MD1; Leslie C. Dort, DDS2; Sheri G. Katz, DDS3; Christopher J. Lettieri, MD4; Christopher G. Harrod, MS5; Sherene M. Thomas, PhD5; Ronald D. Chervin, MD6
1Mayo Clinic, Rochester, MN; 2University of Calgary, Calgary, Alberta, Canada; 3Atlanta, GA; 4Walter Reed National Military Medical Center, Bethesda, MD; 5American Academy of Sleep Medicine, Darien, IL; 6University of Michigan, Ann Arbor, MI
Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.
- We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD)
- When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE)
- We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD)
- We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE)
- We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE)
- We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE)
The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations.
J Clin Sleep Med 2015;11(7):773–827.
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