Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Effects and adverse events of a dental appliance for treatment of obstructive sleep apnoea. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea: a randomized study. Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea. A prospective randomized 1-year follow-up study. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea.
The aim of this study was to evaluate the effect of a m and ibular advancement splint ( MAS ) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea ( OSA ) .  Using a r and omized crossover design , patients received 4 weeks of treatment with MAS and a control device ( inactive oral appliance ) , with an intervening 1-week washout . At the end of each treatment period , patients were reassessed by question naire , polysomnography , and multiple sleep latency test .  Fifty-nine men and 14 women with a mean ( + /- SD ) age of 48 + /- 11 years and proven OSA experienced a significantly improved mean ( + /- SEM ) sleep latency on the multiple sleep latency test ( 10.3 + /- 0.5 versus 9.1 + /- 0.5 minutes , p = 0.01 ) and Epworth sleepiness scale score ( 7 + /- 1 versus 9 + /- 1 , p < 0.0001 ) with the MAS compared with the control device after 4 weeks . The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device ( 82 versus 62 % , p < 0.01 ) , but this was not so for objective sleepiness ( 48 versus 34 % , p = 0.08 ) . Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device . MAS therapy improves a range of symptoms associated with OSA M and ibular repositioning splints ( MRSs ) and continuous positive airway pressure ( CPAP ) are used to treat the sleep apnea/hypopnea syndrome ( SAHS ) . There are some data suggesting that patients with milder symptoms prefer MRS , but there are few comparative data on outcomes . Therefore , we performed a r and omized crossover trial of 8 weeks of CPAP and 8 weeks of MRS treatment in consecutive new out patients diagnosed with SAHS ( apnea/hypopnea index [ AHI ] > or= 5/hour , and > or= 2 symptoms including sleepiness ) . Assessment s at the end of both limbs comprised home sleep study , subjective ratings of treatment value , sleepiness , symptoms , and well-being , and objective tests of sleepiness and cognition .  Forty-eight of 51 recruited patients completed the trial ( 12 women ; age [ mean + /- SD ] , 46 + /- 9 years ; Epworth 14 + /- 4 ; median AHI , 22/hour ; interquartile ratio [ IQR ] , 11 - 43/hour ) . Significant ( p < or= 0.01 ) differences between MRS and CPAP were observed for 7 of 21 variables ( effect sizes , 0.3 - 0.6 SDs ) , all favoring CPAP , including AHI ( 15 + /- 16 and 8 + /- 6/hour , respectively ) , effectiveness rating , symptoms , Epworth ( 12 + /- 5 and 8 + /- 5 , respectively ) , functional outcomes of sleepiness question naire , short-form 36 health survey mental component , and health transition scores . Objective sleepiness , cognitive performance , and preference for treatments were not different . In patients experiencing a mild form of the syndrome ( AHI < 15 , n = 18 ) , symptoms , treatment efficacy and satisfaction , and subjective sleepiness were also better with CPAP than with MRS ( effect sizes , 0.7 - 1.1 SDs ) . These results do not support these MRS devices as first-line treatment for sleepy patients with SAHS The enthusiasm for uvulopalatopharyngoplasty ( UPPP ) in the treatment of obstructive sleep apnoea ( OSA ) has declined in recent years , partly because of a lower success rate over time and partly because of adverse effects . Reports on the beneficial effects of dental appliances exist , but only one prospect i ve r and omized study has been published comparing dental appliances with nasal continuous positive airway pressure ( CPAP ) treatment . No study has been published comparing dental appliance treatment with UPPP .  Ninety-five male patients with confirmed OSA , subjective daytime sleepiness and an apnoea index ( AI ) > 5 were r and omized for subsequent treatment with either a dental appliance or UPPP . There were 49 patients in the dental appliance group and 46 in the UPPP group . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 12-month follow-up . The success rate ( rate of patients with at least a 50 % reduction in AI ) for the dental appliance group was 95 % , which was significantly higher ( p < 0.01 ) than the 70 % success rate for the UPPP group . According to the criteria for OSA ( apnoea index > or = 5 or apnoea/hypopnoea index > or = 10 ) , 78 % of the dental appliance group and 51 % of the UPPP group were normalized after 12 months . The difference between the groups was significant ( p < 0.05 ) . These findings suggest that the dental appliance technique is useful in the treatment of mild to moderate OSA The purpose of this study was to investigate the effects of an oral appliance ( OA ) , with and without m and ible advance , in the treatment of  obstructive sleep apnea syndrome ( OSA ) . Twenty-four patients diagnosed with OSA agreed to participate in this study . The patients were treated for 3 months ( with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening ) . Patients were selected , using a r and omized design , to receive an OA model either with ( 12 patients ) or without advance ( 12 patients ) . Before treatment , a snoring question naire , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , the Functional Outcomes of Sleep Question naire ( FOSQ ) , the Epworth Sleepiness Scale ( ESS ) , and polysomnography  were completed . Fifteen subjects completed the protocol ( 13 men , two women ) . With respect to basal values , the m and ible-advanced OA group presented a decrease in the mean apnea – hypopnea index ( AHI ) ( 33.8±4.7 versus 9.6±2.1 ; p<0.01 ) , number of arousals per hour ( 33.8±13.9 versus 16.0±1.5 ; p<0.05 ) , ESS score ( 14.7±5.1 versus 5.1±1.9 ; p<0.05 ) , snoring score ( 15.4±1.9 versus 10.1±3.2 ; p<0.05 ) , and total FOSQ score ( 78.1±22.6 versus 99.3±14.4 ; p<0.05 ) . After treatment , the non-advanced group presented a decrease in the mean AHI ( 24.0±12.2 versus . 11.7±7.9 ; p<0.05 ) . However , no significant differences were found in the number of arousals per hour , ESS score , snoring , and total FOSQ score in the non-advanced group . Neither study group showed significant difference in mean SF36 scores . Oral appliances , especially those that advance the m and ible , offer an effective treatment for OSA STUDY OBJECTIVE To investigate the short-term effect ( 4 weeks ) of oral appliance therapy for obstructive sleep apnea on blood pressure .  DESIGN R and omized , controlled , crossover trial . SETTING Multidisciplinary sleep disorders clinic in a university teaching hospital . PATIENTS Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography ( apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms -- daytime sleepiness , snoring , witnessed apneas , fragmented sleep ; age > 20 years ; and minimum m and ibular protrusion of 3 mm ) . INTERVENTION A m and ibular advancement splint ( MAS ) and control oral appliance for 4 weeks each . MEASUREMENTS AND RESULTS Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period . Patients showed a 50 % reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index . There was a significant reduction with the MAS in mean ( + /- SEM ) 24-hour diastolic blood pressure ( 1.8 + /- 0.5 mmHg ) compared with the control ( P = .001 ) but not in 24-hour systolic blood pressure . Awake blood-pressure variables were reduced with the MAS by an estimated mean ( + /- SEM ) of 3.3 + /- 1.1 mmHg for systolic blood pressure ( P = .003 ) and 3.4 + /- 0.9 mmHg for diastolic blood pressure ( P < .0001 ) . There was no significant difference in blood pressure measured asleep . CONCLUSION Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure , similar to that reported with continuous positive airway pressure therapy In a prospect i ve study , 95 patients with mild to moderate obstructive sleep apnoea ( OSA ) were r and omised to receive either surgical treatment , uvulopalatopharyngoplasty , ( 4 - 6 patients ) or treatment with a nocturnal dental appliance for m and ibular advancement  ( 49 patients ) . Of the 49 dental appliance patients , 37 completed the 12-month follow-up . The aim of this study was to evaluate the effects and adverse events of dental appliance treatment from a one-year perspective . Somnography was employed to measure treatment effects before and 12 months post-treatment . At the 12-month control , somnography was performed twice : the first time with the dental appliance and the second time without it . Adverse events were recorded 2 weeks and 3 , 6 , and 12 months after treatment was initiated . The patients used the dental appliance on average 6 nights/week . After 12 months of treatment , the apnoea , apnoea/hypopnoea , oxygen desaturation , and snoring indices decreased significantly . Ninety-five per cent of the patients reduced their apnoea index by > or = 50 % and 78 % of the patients were normalised following treatment . At the somnographic registration without the dental appliance , the values were found comparable to what they were before treatment . M and ibular mobility and occlusion were constant throughout the study . The adverse events result ing from using the dental appliance were relatively minor and infrequent , and no serious complications were observed except for two patients who reported pain from the temporom and ibular joint . In conclusion , the dental appliance has been shown to be a valuable treatment method for mild to moderate OSA with few adverse events in the stomatognathic system or other complications STUDY OBJECTIVES This study aim ed to assess the efficacy of a custom-made m and ibular advancement splint for the treatment of obstructive sleep apnea with respect to neuropsychological functioning and mood state . METHODS A r and omized controlled crossover design was used in which 73 participants ( mean age = 48.4 , SD = 11.0 , % men = 80.8 ) with at least 2 symptoms of obstructive sleep apnea and an apnea hypopnea index > or = 10 per hour underwent treatment with both m and ibular advancement splint and an inactive oral device .  Polysomnographic , neuropsychological and self-report measures were conducted at baseline and repeated after each of the two 4-week treatment phases . RESULTS MAS treatment was associated with improvements on the somatic component of the Beck Depression Inventory and the Vigor-Activity and Fatigue-Inertia scales of the Profile of Mood States . While there were no improvements within the neuropsychological domains of attention/working memory , verbal memory , visuospatial or executive functioning , treatment with the m and ibular advancement splint was associated with faster performance on a test of vigilance/psychomotor speed . These changes , however , did not correspond to the improved subjective sleepiness or apnea-hypopnea index during treatment . CONCLUSIONS Treatment with the m and ibular advancement splint results in improvements in self-reported sleepiness , fatigue/energy levels and vigilance/psychomotor speed in patients with obstructive sleep apnea Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea ( OSA ) , the evidence base for this is weak . Furthermore , the precise mechanisms of action are uncertain . We aim ed to systematic ally investigate the efficacy of a novel m and ibular advancement splint ( MAS ) in patients with OSA . The sample consisted of 28 patients with proven OSA . A r and omized , controlled three-period ( ABB/BAA ) crossover study design was used . After an acclimatization period , patients underwent three polysomnographs with either a control oral plate , which did not advance the m and ible ( A ) , or MAS ( B ) , 1 wk apart , in either the ABB or BAA sequence . Complete response ( CR ) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index ( AHI ) to < 5/h , and partial response ( PR ) as a > or = 50 % reduction in AHI , but remaining > or = 5/h . Twenty-four patients ( 19 men , 5 women ) completed the protocol . Subjective improvements with the  MAS  were reported by the majority of patients ( 96 % ) . There were significant improvements in AHI ( 30 + /- 2/h versus 14 + /- 2/h , p < 0.0001 ) , MinSa(O(2 ) ) ( 87 + /- 1 % versus 91 + /- 1 % , p < 0.0001 ) , and arousal index ( 41 + /- 2/h versus 27 + /- 2/h , p < 0.0001 ) with MAS , compared with the control . The control plate had no significant effect on AHI and MinSa(O(2 ) ) . CR ( n = 9 ) or PR ( n = 6 ) was achieved in 62.5 % of patients . The MAS is an effective treatment in some patients with OSA , including those patients with moderate or severe OSA BACKGROUND Although oral appliances are effective in some patients with obstructive sleep apnoea ( OSA ) , they are not universally effective . A novel anterior m and ibular positioner ( AMP ) has been developed with an adjustable hinge that allows progressive advancement of the m and ible . The objective of this prospect i ve crossover study was to compare efficacy , side effects , patient compliance , and preference between AMP and nasal continuous positive airway pressure ( nCPAP ) in patients with symptomatic mild to moderate OSA . METHODS Twenty four patients of mean ( SD ) age 44.0 ( 10.6 ) years were recruited with a mean ( SD ) body mass index of 32.0 ( 8.2 ) kg/m2 , Epworth sleepiness score 10.7 ( 3.4 ) , and apnoea/hypopnoea index 26.8 (11.9)/hour . There was a two week wash-in and a two week wash-out period and two treatment periods ( AMP and nCPAP ) each of four months . Efficacy , side effects , compliance , and preference were evaluated by a question naire and home sleep monitoring . RESULTS One patient dropped out early in the study and three refused to cross over so treatment results are presented on the remaining 20 patients . The apnoea/hypopnoea index ( AHI ) was lower with nasal CPAP 4.2 (2.2)/hour than with the AMP 13.6 (14.5)/hour ( p < 0.01 ) . Eleven of the 20 patients ( 55 % ) who used the AMP were treatment successes ( reduction of AHI to < 10/hour and relief of symptoms ) , one ( 5 % ) was a compliance failure ( unable or unwilling to use the treatment ) , and eight ( 40 % ) were treatment failures ( failure to reduce AHI to < 10/hour and /or failure to relieve symptoms ) . Fourteen of the 20 patients ( 70 % ) who used nCPAP were treatment successes , six ( 30 % ) were compliance failures , and there were no treatment failures . There was greater patient satisfaction with the AMP ( p < 0.01 ) than with nCPAP but no difference in reported side effects or compliance . CONCLUSIONS AMP is an effective treatment in some patients with mild to moderate OSA and is associated with greater patient satisfaction than nCPAP This r and omized placebo-controlled cross-over trial assessed the effectiveness of a m and ibular advancement appliance ( MAA ) in managing  obstructive sleep apnoea ( OSA ) . Twenty-one adults , with confirmed OSA , were provided with a maxillary placebo appliance and a MAA for 4 - 6 weeks each , in a r and omized order . Question naires at baseline and after each appliance assessed bed-partners ' reports of snoring severity ( loudness and number of nights per week ) , and patients ' daytime sleepiness ( Epworth Sleepiness Score , ESS ) . The Apnoea Hypopnoea Index ( AHI ) and Oxygen Desaturation Index ( ODI ) were measured at baseline and with each appliance during single night sleep studies . Seventy-nine per cent of subjects wore their MAA for at least 4 hours at night . Sixty-eight per cent of subjects wore their MAA for 6 - 7 nights per week . Excessive salivation was the most commonly reported complication . One subject was unable to tolerate the MAA and withdrew from the study . Among the remaining 20 subjects , the MAA produced significantly lower AHI and ODI values than the placebo . However , although the reported frequency and loudness of snoring and the ESS values were lower with the MAA than the placebo , these differences were not statistically significant . When wearing the MAA , 35 per cent of the OSA subjects had a reduction in the pre-treatment ODI to 10 or less , while 33 per cent had an AHI of 10 or less . The MAA was less effective in the subjects with the most severe OSA ( pre-treatment ODI > 50 and /or pre-treatment AHI > 50 ) This prospect i ve , r and omized , cross-over trial was design ed to compare the efficacy of a m and ibular advancement splint ( MAS ) with that of nasal continuous positive airway pressure ( nCPAP ) in patients with obstructive sleep apnoea ( OSA ) . Twenty-four patients ( 20 males and four females ) with mild to moderate OSA ( AHI between 10 and 49 events per hour ) were enrolled in the study . Each patient used both MAS and nCPAP , with the initial therapy being allocated at r and om . Treatment periods lasted for two months with a two-week wash-out interval between .  Polysomnography  was performed prior to the study and after each clinical intervention . Patient and partner question naires were used to assess changes in general health and daytime somnolence . The AHI decreased from 22.2 to 3.1 using nCPAP , and to 8.0 using the MAS ( P < 0.001 for both devices ) and there was no statistically significant difference between the two treatments . The Epworth Sleepiness Score ( ESS ) fell from 13.4 to 8.1 with nCPAP , and to 9.2 with MAS ( P < 0.001 ) , again with no differences between the use of MAS or nCPAP . The question naire data showed an improvement in general health scores ( P < 0.001 ) after both treatments , but daytime sleepiness only improved significantly using nCPAP ( P < 0.001 ) . Despite this , 17 out of the 21 subjects who completed both arms of the study preferred the MAS . The splints were well tolerated and their efficacy suggests that the MAS may be a suitable alternative to nCPAP in the management of patients with mild or moderate OSA STUDY OBJECTIVE To compare efficacy , side effects , patient compliance , and preference between oral appliance ( OA ) therapy and nasal-continuous positive airway pressure ( N-CPAP ) therapy . DESIGN R and omized , prospect i ve , crossover study . SETTING University hospital and tertiary sleep referral center . PATIENTS Twenty-seven unselected patients with mild-moderate obstructive sleep apnea ( OSA ) . INTERVENTIONS There was a 2-week wash-in and a 2-week wash-out period , and 2 x 4-month treatment periods ( OA and N-CPAP ) . Efficacy , side effects , compliance , and preference were evaluated by a question naire and home sleep monitoring . MEASUREMENTS AND RESULTS Two patients dropped out early in the study and treatment results are presented on the remaining 25 patients . The apnea/hypopnea index was lower with N-CPAP ( 3.5 + /- 1.6 ) ( mean + /- SD ) than with the OA ( 9.7 + /- 7.3 ) ( p < 0.05 ) . Twelve of the 25 patients who used the OA ( 48 % ) were treatment successes ( reduction of apnea/hypopnea to < 10/h and relief of symptoms ) , 6 ( 24 % ) were compliance failures ( unable or unwilling to use the treatment ) , and 7 ( 28 % ) were treatment failures ( failure to reduce apnea/hypopnea index to < 10/h and /or failure to relieve symptoms ) . Four people refused to use N-CPAP after using the OA . Thirteen of the 21 patients who used N-CPAP were overall treatment successes ( 62 % ) , 8 were compliance failures ( 38 % ) , and there were no treatment failures . Side effects were more common and the patients were less satisfied with N-CPAP ( p < 0.005 ) . Seven patients were treatment successes with both treatments , six of these patients preferred OA , and one preferred N-CPAP as a long-term treatment . CONCLUSIONS We conclude that OA is an effective treatment in some patients with mild-moderate OSA and is associated with fewer side effects and greater patient satisfaction than N-CPAP The aim of this prospect i ve , r and omized study was to analyze dental and skeletal side effects after 4 years of treating obstructive sleep apnea ( OSA ) patients with a m and ibular advancement device ( MAD ) compared with uvulopalatopharyngoplasty ( UPPP ) . With the appliance in position , the m and ible was advanced 50 % of maximum protrusion capacity ( ie , 4 - 6 mm ) ; the vertical opening between the incisal edges was , on average , 3 mm . Thirty patients in the MAD group and 37 in the UPPP group completed the 4-year follow-up . There were no differences between the MAD and the UPPP groups in any of the dental or skeletal variables measured after the 4-year treatment period . In the MAD group , small but statistically significant changes were found : there was a posterior rotation of the m and ible ( m and ibular line [ML]/nasion-sella line [ NSL ] ) ( mean 0.5 degrees [ 95 % confidence interval ( CI ) 0.1 - 0.8 degrees ] ) . Correlated to the posterior rotation of the m and ible , the distances incision superius ML , incision superius-NSL , and incision inferius-NSL increased by means ( 95 % CI ) of 0.7 ( 0.5 - 1.2 ) , 0.8 ( 0.4 - 1.1 ) , and 1.3 ( 0.8 - 1.8 ) mm , respectively . Overjet and overbite did not change significantly , nor was there a significant change in the m and ibular length . The observed changes were considered clinical ly insignificant because overbite and overjet stayed within normal limits . Only the vertical position of the maxillary incisors in relation to ML changed to the extent that the 95 % CI of the mean for the change was outside that of the mean of the change in the UPPP group and measurement error . Treatment of OSA with a dental appliance is probably a lifelong process , and long-term follow-up studies should therefore be undertaken to control both the treatment effect on OSA and the side effects on the masticatory system STUDY OBJECTIVES To evaluate the effects of treatment with a dental appliance or uvulopalatopharyngoplasty ( UPPP ) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea ( OSA ) followed up for 4 years , and compliance and complementary treatment . DESIGN R and omized study . SETTING Central Hospital , Västerås , Uppsala University , Sweden . PATIENTS Ninety-five male patients with confirmed mild-to-moderate OSA ( apnea index [ AI ] > 5 and < 25 ) were r and omized to treatment with a dental appliance or UPPP .  Sleep studies were performed before and 1 year and 4 years after intervention . Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up . RESULTS The success rate ( percentage of patients with at least 50 % reduction in AI ) in the dental-appliance group was 81 % , which was significantly higher than in the UPPP group , 53 % ( p < 0.05 ) . Normalization ( AI < 5 or apnea/hypopnea index < 10 ) was observed in 63 % of the dental-appliance group and 33 % of the UPPP group after 4 years . The difference between the groups was significant ( p < 0.05 ) . The compliance to use of the dental appliance was 62 % at the 4-year follow-up . Thirty patients ( 75 % ) in the UPPP group continued without complementary treatment . The dental appliances had few adverse effects on the stomatognathic system , and the number of adjustments and repairs of the appliances over time was moderate . Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty with swallowing after UPPP were reported by 8 % and 10 % , respectively . CONCLUSIONS The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group , but the effectiveness of the dental appliance was partly invali date d by the compliance of 62 % at the 4-year follow-up . However , the appliances had few adverse effects on the stomatognathic system and required only moderate adjustments . Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA The objectives of this study were : to evaluate the change in the three quality of life ( QOL ) dimensions of vitality , contentment and sleep before intervention and 1 year after treatment with a dental appliance or uvulopalatopharyngoplasty ( UPPP ) ; to compare the effect of treatment between these two treatment groups on these three dimensions ; and to determine the relation between the QOL scores and somnographic values . Ninety-five patients with mild to moderate obstructive sleep apnoea ( OSA ) ( AI > 5 ) were r and omly allocated to either a dental appliance or UPPP treatment group . Seven patients withdrew after r and omization but before treatment , leaving 88 patients eligible for treatment . The patients were examined using somnography and administered the Minor Symptoms Evaluation-Profile ( MSE-P ) , a QOL question naire , before and 1 year after intervention . Thirty-seven patients in the dental appliance group and 43 in the UPPP group completed the 1-year follow-up . The mean values for the three dimensions vitality , contentment and sleep improved significantly 1 year after intervention in the dental appliance and UPPP groups . No difference in the QOL scores at baseline was noted between the groups . One year after intervention the UPPP group showed significantly more contentment than the dental appliance group . In contrast , vitality and sleep dimensions did not differ between the two treatment groups . No significant correlations were observed between the QOL scores and somnographic values . In conclusion , quality of life improved significantly in the dental appliance and UPPP groups 1 year after intervention . However , the dental appliance group showed a lower level of contentment than the UPPP group , even though the somnographic values were superior in the former group BACKGROUND For the treatment of nonsevere obstructive sleep apnea syndrome ( OSAS ) , m and ibular advancement devices ( MADs ) are employed as an alternative to nasal continuous positive airway pressure ( CPAP ) therapy . However , very few specific data on the effectiveness of MADs in this group of patients are available . We therefore compared an individually adjustable intraoral sleep apnea device ( ISAD ) that permits movements of the lower jaw in three dimensions , with CPAP in the treatment of patients with an apnea/hypopnea index ( AHI ) < or = 30/h . METHODS In a r and omized crossover study , 16 men and 4 women ( mean + /- SD age , 56.5 + /- 10.2 years ; body mass index , 31.2 + /- 6.4 ; AHI , 17.5 + /- 7.7/h ) were treated for 6 weeks with each modality . RESULTS In the initial phase , a significant improvement in AHI ( baseline , 17.5 + /- 7.7/h ; ISAD , 10.5 + /- 7.5/h [ p < 0.05 ] ; CPAP , 3.5 + /- 2.9/h [ p < 0.01 ] ) and in breathing-related arousals ( baseline , 8.9 + /- 6.1/h ; ISAD , 3.7 + /- 3.3/h [ p < 0.01 ] ; CPAP , 1.4 + /- 1.6/h [ p < 0.01 ] ) was achieved with both modalities . Considering all 20 subjects , after 6 weeks of treatment , normalization of the respiratory parameters was seen only with CPAP . However , 30 % of the patients had a lasting reduction in AHI to < 10/h with the ISAD also . The patients considered the ISAD to be easier to use ( scale of 1 to 6 : ISAD , 1.8 + /- 1.1 ; CPAP , 3.1 + /- 1.5 [ p < 0.05 ] ) , and indicated greater utilization of the device in comparison with CPAP . CONCLUSION Even in patients with mild-to-moderate OSAS , CPAP is the more effective long-term treatment modality . In the individual case , the better compliance seen with the ISAD may be advantageous The efficacy of currently recommended treatments is uncertain in patients with mild to moderate obstructive sleep apnea ( apnea-hypopnea index [ AHI ] , 5 - 30 ) . A group of 114 sleep clinic patients with an AHI of 5 - 30 have participated in a r and omized controlled crossover trial of 3 months of treatment with each of nasal continuous positive airway pressure ( CPAP ) , a m and ibular advancement splint , and a placebo tablet . Outcomes were sleep fragmentation and hypoxemia , daytime sleepiness , quality of life , neurobehavioral function , and blood pressure . Both active treatments improved sleep outcomes , but positive airway pressure had a greater effect . The quality of life , symptoms , and subjective but not objective sleepiness improved to a similar degree with both treatments ; however , many of the improvements seen in neuropsychologic function and mood were not better than the placebo effect . Some aspects of nocturnal blood pressure were improved with the splint but not with CPAP . This study has shown that although both CPAP and m and ibular advancement splint effectively treated sleep-disordered breathing and sleepiness , the expected response in neurobehavioral function was incomplete . This may be due to the splint having a lesser therapeutic effect and CPAP being poorly tolerated and therefore used less in this patient group
BACKGROUND Obstructive sleep apnoea-hypopnoea is a syndrome characterised by recurrent episodes of partial or complete upper airway obstruction during sleep that are usually terminated by an arousal .
Nasal continuous positive airway pressure is the primary treatment for obstructive sleep apnoea-hypopnoea , but many patients are unable or unwilling to comply with this treatment .
Oral appliances are an alternative treatment for sleep apnoea .
OBJECTIVES The objective was to review the effects of oral appliance in the treatment of  sleep apnoea in adults .