Many people who try CPAP for sleep apnea have difficulty adapting to the treatment. These people may spend months working with their sleep doctor to try to make CPAP work for them, and for many people CPAP will never work.
Oral appliances are a CPAP alternative, and they’re often highly effective, so effective that they’re just as good as or better than CPAP. Identifying the patients for whom oral appliances are most effective and recommending them as a frontline treatment can save people from the trouble and expense of trying CPAP. That’s why researchers are hopeful about the results of their study into which people respond best to oral appliance therapy.
Who Benefits Most from Oral Appliances?
For this study, researchers looked at 93 patients who had polysomnography (sleep test). They looked at five traits they could identify from the sleep test results:
- Pharyngeal collapsibility
- Muscle compensation
- Loop gain
- Arousal threshold
- Response to arousal
They found that patients with moderate collapsibility of their throat paired with weaker muscle compensation to collapse responded best. Loop gain is a measure of how the body responds to disturbed breathing. People with high loop gain tend to have long periods of unstable breathing after a disturbance. This makes them poor candidates for oral appliance therapy. Arousal threshold is how much disturbance it takes to wake someone. Higher thresholds are better for oral appliance therapy. Finally, the response to arousal measures how actively people will respond to arousal. Low arousal response is better for oral appliance therapy.
How Much of a Difference?
Using the above five characteristics, researchers divided their 93 patients into groups they expected would respond well to oral appliances (58%) and those they thought wouldn’t (42%). They then had patients repeat their sleep test with oral appliances.
The predicted responders saw a dramatic 73% drop in apnea-hypopnea index (AHI). The predicted poor responders only saw a 51% drop. Predicted responders saw their AHI drop down to just 8–very mild sleep apnea. Non-responders only saw their AHI drop to 16. Analysis proved these differences were statistically significant and persisted despite other relevant characteristics.
We Can Usually Predict Who Will Respond
The work of these researchers highlights something we have long been doing in our office: pre-screening candidates for oral appliances. Our experience gives us a very good idea of who will likely benefit from oral appliances, and we evaluate candidates before we create oral appliances. That way, most of our patients who get oral appliances actually do see the results they are looking for. Doctors rarely do the same for CPAP, which is why it’s a good idea to consider oral appliance therapy before committing to CPAP. We will help you find the best sleep treatment for you, not just the one that’s recommended for anyone.
Would you like to learn whether you are a good candidate for oral appliance therapy? Please call (402) 493-4175 today for an appointment with an Omaha sleep dentist at the Advanced Dental Sleep Treatment Center.
