An excellent article confirms the efficacy and mechanism of action of oral appliances in the treatment of obstructive sleep apnea. CPAP was once considered the first choice for treating all patients with sleep apnea but because of dismal compliance by patients Dental Sleep Medicine is becoming increasingly important as more and more patients switch to oral appliances. This study in Arch Otolaryngol Head Neck Surg. 2009 Sep;135(9):910-4 evaluated the effects of a mandibular advancement device (MAD) and confirmed efficacy and mechanism of action of these appliances with sleep videofluoroscopy.

According to the authors the “MAD had marked effects on the length of the soft palate, retropalatal space, retrolingual space, and angle of mouth opening.” They etermined that the oral appliances worked in numerous ways and specifically “The MAD increased the retropalatal and retrolingual spaces and decreased the length of the soft palate and the angle of mouth opening, resulting in improvement of OSA.” This is great news for the 60% of patients with obstructive sleep apnea who do not tolerate CPAP. Patients wishing to learn mora about the various types of oral appliances available can view them at http://www.ihatecpap.com/oral_appliance.html

The site was create by Dr Ira L Shapira a Diplomate of the American Board of Dental Sleep Medicine, a member of the American Academy of Sleep Medicine and The American Academy of Dental Sleep Medicine and Founder of Chicagolan Dental Sleep Medicine Associates.

THE PUBMED ABSTRACT IS LISTED BELOW FOR YOUR CONVENIENCE.
Arch Otolaryngol Head Neck Surg. 2009 Sep;135(9):910-4.
An investigation of upper airway changes associated with mandibular advancement device using sleep videofluoroscopy in patients with obstructive sleep apnea.
Lee CH, Kim JW, Lee HJ, Yun PY, Kim DY, Seo BS, Yoon IY, Mo JH.

Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Bundang-Gu, Seongnam, Korea.
OBJECTIVE: To quantitatively evaluate the effects of the mandibular advancement device (MAD) on changes in the upper respiratory tract during sleep using sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea (OSA). DESIGN: Retrospective analysis. SETTING: Academic tertiary referral center. PATIENTS: Seventy-six patients (68 men and 8 women) who were treated with the MAD for OSA were included from September 1, 2005, through August 31, 2008. INTERVENTION: All patients underwent nocturnal polysomnography and SVF before and at least 3 months after receipt of the custom-made MAD. Sleep videofluoroscopy was performed before and after sleep induction and was analyzed during 3 states of awakeness, normoxygenation sleep, and desaturation sleep. MAIN OUTCOME MEASURES: Changes in the length of the soft palate, retropalatal space, retrolingual space, and angle of mouth opening were evaluated during sleep events with or without the MAD. RESULTS: Without the MAD, the length of the soft palate and the angle of mouth opening increased during sleep events, especially in desaturation sleep, compared with the awake state. The retropalatal space and retrolingual space became much narrower during sleep compared with the awake state. The MAD had marked effects on the length of the soft palate, retropalatal space, retrolingual space, and angle of mouth opening. The retropalatal space and retrolingual space were widened, and the length of the soft palate was decreased. The MAD kept the mouth closed. CONCLUSIONS: Sleep videofluoroscopy showed dynamic upper airway changes in patients with OSA, and the MAD exerted multiple effects on the size and configuration of the airway. Sleep videofluoroscopy demonstrated the mechanism of action of the MAD in patients with OSA. The MAD increased the retropalatal and retrolingual spaces and decreased the length of the soft palate and the angle of mouth opening, resulting in improvement of OSA.