comparable effectiveness of oam and cpap has been attributed to higher reported nightly use of oam, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. current practice parameters of the american academy of sleep medicine (aasm) indicate oam as a first-line therapy in patients with mild-to-moderate osa and in more severe osa patients who fail treatment attempts with cpap therapy.11 recent advances in technologies including remotely controlled mandibular advancement sleep studies and objective adherence monitoring capabilities12,13 are likely to further enhance and support the effectiveness of oam in treatment of osa. reduced snoring was also found to be specifically related to the action of mandibular advancement both by objective measurement using a sound meter16,19 and by subjective bed partner assessment.15,18 these inactive-device controlled studies confirm that oam that jaw protrusion by oam is the key mechanism by which treatment is delivered. the target treatment protrusion identified by this method of sleep titration was found to result in effective treatment in 87% of patients predicted to be successfully treated oam in an initial study. ahi improves on both cpap and oam treatment; however, ahi is reduced to a greater extent with cpap.54–62 differences in the proportion of patients achieving treatment success (variously defined) are also in favor of cpap.
patient choice of treatment may be influenced by an individual’s personality, lifestyle, perceived stigma, and financial status, although patients reported effectiveness of the treatment as paramount in their decision.74 although oam and cpap have been considered as alternative treatment pathways, there is scope for a patient to alternate between them as needed in situations such as travel when cpap may be inconvenient. therefore treatment comparisons need to take into account not only efficacy on treatment but the percentage of sleep time for which a removable device is used, as a high proportion of sleep time not on treatment will reduce the overall effectiveness, even in a highly efficacious device.83 consistent in all studies of oam treatment efficacy is that osa is not adequately alleviated in all patients, and therefore oam will have limited effectiveness in these patients. individual variability in response to oam treatment represents a significant clinical challenge, as implementing therapy in patients who will ultimately not receive benefit is unsatisfactory from both a treatment and cost point of view. mounting evidence suggests that oam and cpap treatment are comparatively effective in improving health outcomes, even in more severe osa,57 presumably due to greater overall usage of the oam device compared to cpap. subsequently, a commercially available temperature data logger was reported in terms of safety105 and used to obtain objective data on oam treatment adherence in 7 patients.106 however the dimensions and storage capacity of this particular temperature data logger were found to be problematic. establishing best quality devices that are objectively validated in terms of both efficacy and durability in combination with recent advances in patient selection and treatment monitoring, will continue to optimize oam as an effective and even first-line treatment for osa.
the preferred method of treating obstructive sleep apnea (osa) is the cpap machine. an alternative treatment is oral appliance therapy. webmd describes the different types of mouth devices used to treat sleep apnea including cpap and mouth guards. not everyone with sleep apnea can use an airway pressure machine, there are oral appliances available, but are they effective?, .
oral appliance therapy treats sleep apnea by helping remove physical blockages from the upper airway. mandibular advancement devices (mads) help oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (osa). an oral appliance fits over your teeth like an oral appliances, fit by qualified dentists, are an alternative treatment for many patients who can’t use or don’t want to use pap therapy. they, .
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