Professor's study on alternative treatments for sleep apnea published in Journal of Dental Research
Phillip D. Wilson, D.D.S., assistant clinical professor in the University of New England College of Dental Medicine (CDM), is one in a team of authors of a clinical research report on oral appliance therapy (OAT) as an alternative treatment for obstructive sleep apnea (OSA), which was recently published in the Journal of Dental Research.
The report, “Randomized Trial of 2 Self-Titrated Oral Appliances for Airway Management,” compared two widely used oral appliance (OAs) designs and tested whether they differed in reducing the respiratory event index (REI) — a figure used to indicate the severity of OSA.
The randomized crossover study examined the differences in reducing REI between two oral appliances: the TAP1 and SomnoDent Flex. Due to design differences, the TAP1 device tends to restrict mouth opening during sleep, while the SomnoDent Flex allows for complete mouth opening. The goal of the research was to determine if these design variances had differing effects and if OAT was even effective in treating OSA.
To complete the study, participants used one dentist-fitted OA nightly for four weeks followed by a one-week washout period, during which participants were instructed to use their CPAP machines instead. This washout period was followed by a second four-week trial during which participants used the alternate OA.
Individuals received training on how to titrate each appliance and were instructed to advance their mandibles based on each manufacturer’s guidelines if they observed any snoring, OSA events, or persistent daytime sleepiness. To measure REI, home sleep recordings were collected using the NOX T3 recorder, and oxygen saturation was measured with a finger probe pulse oximeter.
After nine weeks, the researchers found that both devices demonstrated equivalent REI attenuation regardless of jaw-opening limitations, and both designs significantly reduced the REI in adults with moderate and severe OSA. These findings were somewhat surprising because the current understanding is that OAT was only effective for those suffering from mild OSA, Wilson said.
“When self-titrated over a short period of four weeks, the results suggest that both designs improve upper airway function and stability, reduce its collapsibility, and increase oropharyngeal space,” the team wrote. “Collectively, our data suggest self-titrated OAs can be routinely offered as a treatment option for OSA patients, and clinicians can expect about a 50% response rate and to bring the REI down to about eight to 16 events per hour after eight weeks among patients, including those with severe OSA.”