CPAP or Oral appliances?
A PubMed search containing OSA, CPAP or oral appliances can produce hundreds of clinical articles.
Below are extracts from clinical articles that report on some of the topical issues being considered in sleep medicine today, including treatment of mild OSA, progression of mild OSA and the use of oral appliances or CPAP in mild OSA.
Should we even treat mild OSA?
This recent article shows survivorship of untreated OSA patients at 20 years after their diagnosis. While patients with severe OSA had lower survival (25% at 20 years), only 50% of patients with mild OSA survived at 20 years. The survivorship curves for mild and moderate OSA are almost exactly the same – so why treat moderate OSA and not mild OSA?
Does OSA severity progress?
In this study of 160 patients followed for 5 years:
• For primary snorers with an AHI <5 (black line) – AHI increased from 1.8 to 13.4 over 5 years.
• For mild OSA sufferers with an AHI 5-15 (grey line) – AHI increased from 9.1 to 21.7 over 5 years.
Patients with mild OSA progressed to moderate OSA over this period, demonstrating that treating mild OSA is important.
What about compliance to CPAP in mild OSA patients?
A meta-analysis conducted in 2014 of 12 studies and 1438 patients was clear – patients with mild OSA are less compliant on CPAP:
“I have been using my Somnomed® device for about two years now. It has completely improved the quality of sleep that I get and consequently certain aspects of my life for the better.
On the rare occasion that I forget to put it in the device my sleep deteriorates immediately. It’s invaluable.” Read more
“Having suffered jaw and tooth pain over several months and following several appointments with my GP and regular dentist to no avail, I asked April (dentist) if she could give me a second opinion. After careful consultation April suggested that sleep apnoea and teeth grinding might be behind the issues and recommended a Somnomed® device to wear at night. Read more
“My name is Simon Wilsdon I am a general dentist in York with a special interest in dental sleep medicine. Over several years I have experienced mild sleep apnoea and, unfortunately for my wife, loud snoring. I have tried several different mandibular advancement devices over the years. These have given initial improvement but nothing long lasting and were uncomfortable over time. After investigating different options, I decided to give the new SomnoMed® Avant™ appliance a try. Read more
Mohammed was diagnosed with Severe Sleep Apnoea in 2018.
“For the first year after my diagnosis, I had a CPAP machine in the home, but I really struggled with it, due to the anxiety of the mask being on my face all night. When I saw my Sleep Consultant, I was advised that I should not drive, and my driving license has now been revoked for more than 2 years. I have a family at home, with four children, so having no driving license has really affected our day-to-day lives. Little things like food shopping and trips out are much more difficult. Read more
Like many people, l became aware that l was snoring during the night and feeling tired in the morning. This led me down the route of seeing my GP who felt l may have obstructive sleep apnoea and referred me to the hospital for further tests. There, l was given the Epworth Sleep Study questionnaire to complete which indicated l had daytime sleepiness but not severely. However further investigation was necessary and an overnight hospital stay was arranged where l had a sleep study conducted. Read more