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Title Oral Appliances are Effective for the Treatment of Obstructive Sleep Apnea
Clinical Question Do oral appliances provide effective prevention of OSA in middle-age men when compared to CPAP?
Clinical Bottom Line Oral appliances for the management of OSA provide significant reduction in sleep apnea, and are recommended for patients who cannot tolerate or are non-compliant with CPAP. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17136406Hoffstein/20077 Randomized, crossover trials Systematic Review
Key resultsOral appliance: 42% decrease in sleep apnea index CPAP: 75% decrease in sleep apnea index
#2) 15495109Lim/200410 randomized controlled studiesCochrane Systematic Review with Meta-Analysis
Key resultsCPAP reduces OSA to a significantly greater extent than an oral appliance.
Evidence Search National Library of Medicine (PubMed) was searched using the following search terms: Sleep Apnea, Obstructive/therapy(MeSH); Continuous Positive Airway Pressure (MeSH); oral appliance
Comments on
The Evidence
The conclusions of these papers should be strongly considered due to the high level of evidence. The reviews relied on well controlled studies and provided adequate statistical analysis to support their results.
Applicability The results are applicable to patients (particularly middle-aged men) who are unable or unwilling to tolerate CPAP as a non-invasive alternative to treat OSA.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords CPAP, Sleep apnea, Obstructive airway therapy
ID# 295
Date of submission: 01/28/2010spacer
E-mail smithy@uthscsa.edu
Author Yves K. Smith, DDS
Co-author(s) e-mail
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
Comments and Evidence-Based Updates on the CAT
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by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the effectiveness of OA for OSA was performed Oct 2015. A more recent publication was found: Okuno 2014, PubMed: 24650215. This systematic review including 5 RCTs showed similar results as those published in this CAT. Apnea Hypopnea Index and the arousal index were significantly improved by OA therapy relative to the untreated disease. Apnea Hypopnea Index, lowest SpO2 and QOL were significantly better with CPAP therapy than with OA therapy.
by Marisol Kusbel (San Antonio, TX) on 04/09/2012
A PubMed search on OSA compared to CPAP efficacy was performed April 2012. A more recent publication was found: Hoekema 2008, PubMed: 18719218. This RCT on 103 individuals showed similar results as those published in this CAT and, in addition, indicated OSA therapy should be supported only in patients with non-severe OSA.

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