© 2002 Thorax
EDITORIAL
Obstructive sleep apnoea
Are oral appliances a substitute for nasal positive airway pressure?
Departments of Medicine and Plastic Surgery, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island, USA
Correspondence to:
Correspondence to:
Dr R P Millman, Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, 593 Eddy Street (APC-4), Providence, RI 02903, USA;
rmillman@Lifespan.org
A simple non-adjustable oral appliance is no substitute for nasal positive airway pressure in patients with obstructive sleep apnoea.
Keywords: obstructive sleep apnoea; mandibular advancement devices; nasal continuous positive pressure; asthma; vocal cord dysfunction; laryngeal hyperresponsiveness
Although positive airway pressure (PAP) devices have become the mainstay of treatment for obstructive sleep apnoea, not all patients can or will use PAP on a nightly basis. Many patients find taking a bulky PAP unit on business or vacation trips a burden. In this issue of Thorax Smith and Stradling attempt to show that a simple non-adjustable oral appliance may be used in place of PAP on a short term basis.1 Unfortunately, in only nine of the 50 patients entered into the study was their sleep apnoea controlled with the appliance.
This low success rate of 18% does not concur with the published literature which has reported a success rate of 81% in patients with mild and 60% in patients with moderate sleep apnoea.2 Part of the difference between this study and the previous literature may be related to the type of device used and side
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