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:
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{at}Lifespan.org
- obstructive sleep apnoea
- mandibular advancement devices
- nasal continuous positive pressure
- asthma
- vocal cord dysfunction
- laryngeal hyperresponsiveness
A simple non-adjustable oral appliance is no substitute for nasal positive airway pressure in patients with obstructive sleep apnoea.
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 effects from the device. Smith and Stradling employed a device that had previously been shown to be effective in controlling snoring.3 It consists of two customised sports-type mouth guards fused together to place the mandible in a forward position set at approximately …
