ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Occlusal Splints Are A Suitable Treatment Option For Patients With A Mild Form Of Sleep Apnea
Clinical Question In a 50 year old overweight male, will use of a Klearway dental appliance reduce the occurrence and severity of mild sleep apnea and snoring better than the use of a continuous positive airway pressure device?
Clinical Bottom Line Mandibular advancement splints may provide comparable relief to continuous positive airway pressure in relieving mild to moderate obstructive sleep apnea. (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) 19362029McDaid/2009Unstated number of patients with varying degrees of sleep apnea, divided into “severe,” “moderate,” and “mild.”Systematic Review
Key resultsCPAP significantly reduced subjective sleepiness, and objective sleepiness (for one out of two objectives scales used), especially for patients whose apnea was most severe at baseline. CPAP did not differ from dental splints in reducing sleepiness for patients with moderate, but not severe, apnea.
#2) 18719218Hoekema/2008667 patients of at least 21 years of age, with obstructive sleep apnea syndromeIndividual randomized controlled trial
Key resultsMandibular repositioning splints compared favorably to non-repositioning control splints as measured both objectively and subjectively. Repositioning splints were equivalently effective to CPAP when assessed by the subjective Epworth Sleepiness Scale, but less effective than CPAP when assessed by the objective apnea-hypopnea index.
Evidence Search Limits: English, Systematic ReviewsEnglish, Systematic ReviewsMeta-Analysis, English "Occlusal Splints"[Mesh]Search "Continuous Positive Airway Pressure"[Mesh] Search "Sleep Apnea, Obstructive"[Mesh]
Comments on
The Evidence
Only the abstract, not the full text, of the McDaid paper is available for review. Therefore key information, such as the number of trials and number of patients included, was unavailable to us but as this was a more recent systematic review than Hoekema we deemed it worth noting. The Hoekema review, available to us in full, documented a discriminating and extensive review of the literature through 2002.
Applicability Patients with a “mild” form of sleep apnea.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Prosthodontics)
Keywords Sleep Apnea, Dental Appliance, Occlusal Splint, Continuous Positive Airway Pressure
ID# 635
Date of submission: 05/06/2010spacer
E-mail whitsont@livemail.uthscsa.edu
Author Travis Whitson
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl, II, DMD, PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Ryushiro Sugita, DDS (San Antonio, Texas) on 11/17/2015
A PubMed search on the effectiveness of occlusal splints for patients with mild obstructive sleep apnea was performed Oct 2015. A more recent publication was found: Ramar in 2014, PubMed: 26094920. The meta-analysis using the limited available evidence revealed that occlusal splints can significantly reduce the apnea hypopnea index/ respiratory disturbance index/respiratory event index (AHI/ RDI/REI) across all levels of OSA severity in adult patients. Additionally, based on a single retrospective study by Holley in 2011 there was no significant difference between Occlusal splints and CPAP in the percentage of mild OSA patients achieving their target AHI/RDI/ REI (< 5, < 10, > 50% reduction) after treatment.
by Komal Suri; Courtney Schwind & Kevin Lin (San Antonio, Texas) on 01/06/2014
We conducted a search on January 2014 on the effectiveness of occlusal splints for patients with obstructive sleep apnea and found an article written by Brette in 2012 (PMID 23122735). The article’s results showed about a 76% success rate with the use of occlusal splits to effectively treat sleep apnea who used it regular. However, there was 24% who stopped treatment and about half of those fell back on continuous positive airway pressure. In our opinion, the information is still compatible with the earlier research conducted in the CAT.
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