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Compliance, titration and side effects of oral appliances in snoring and obstructive sleep apnea patients De Almeida, Fernanda Ribeiro


Long-term compliance, titration modalities and side effects of oral appliances (OAs), used for the management of snoring and obstructive sleep apnea (OSA), have been investigated in a large sample of subjects. The majority of patients were compliant with OA treatment (64.1%) after a mean period of 5.7 years. The most frequent reasons why patients discontinued wear were uncomfortable (44.4%), had little or no effect (33.6%), or switched to nasal Continuous Positive Airway Pressure (23.3%). Side effects, such as dry mouth and tooth and/or jaw discomfort, were more frequent and more severe in non-compliant subjects (p<0.05). Subjects who were compliant with OA therapy reported long periods of use, a lower perception of side effects and a greater decrease in snoring as compared to the non-compliant. In order to improve efficacy, an apnea monitor revealed a good correlation of 0.805 with polysomnography. In the calculation of a receiver operating characteristic curve at a threshold value of apnea and hypopnea index (AHI) of 10/hour, the area under the curve was 0.915. The tested snoring monitor (based on a nasal cannula pressure transducer), when compared to a noise level meter, presented a significant correlation of 0.77 and its correlation with the AHI was r = 0.47 for patients with an AHI smaller than 30/h. These instruments are probably useful tools to improve the titration of OAs and consequently increase OA effectiveness. Over a mean period of 7.3 years, OAs induce changes in the dental structures that appear to be progressive over time when measured by cephalometric and study model analyses. These changes were expressed as a decrease in overbite and overjet of 2.8 and 2.6 mm respectively, retroclination of the maxillary incisors and proclination of the mandibular incisors. Interestingly, for half of those patients, the changes were considered favorable for their occlusion. Favorable changes were also correlated with a greater initial overjet. Since OSA is a life-threatening disease, OA therapy should be maximized in terms of compliance and efficacy and override the concept that only maintenance of a baseline occlusion is important. Long-term follow-up should be encouraged in all OA clinical protocols.

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