Oral appliance therapy is an effective and discreet option in the treatment of obstructive sleep apnea (OSA). Today let’s discuss several reasons why it is important to perform a sleep test with the device inserted if your physician or medical provider has recommended one.
In most cases, oral appliance therapy involves the construction of custom dental retainers that resemble sports mouthguards or orthodontic retainers. Custom sleep apnea dental devices are called oral appliances or mandibular advancement splints. These custom-made mouthguards reposition and stabilize the jaw in a forward position preventing muscles and tissues from collapsing back into the airway which cause apnea events.
Average success rates confirm that oral appliances (dental sleep apnea mouthguards) are effective in up to 80% of individuals who suffer with OSA.
Full success for oral appliance therapy includes cessation or reversal of symptoms such as excessive daytime sleepiness, morning headaches, snoring, and poor sleep quality. Additionally and very importantly, success also includes the elimination of oxygen depriving and sleep disrupting apnea events.
Many people who obtain a sleep apnea dental device often are convinced the device is fully working because their symptoms (snoring, headaches, drowsiness) are no longer present. However, in approximately 50% of these patients who feel that they are adequately treated, there are residual apnea events still occurring. In these cases, the oral sleep apnea device may need further adjustments to resolve apnea events and maintain healthy sleep blood -oxygen levels.
Residual apnea events can lead to:
- High blood pressure
- Pulmonary hypertension
- Cerebrovascular Disease
- Cardiac Arrhythmia
- Myocardial Ischemia
- Higher incidence of strokes
- Erectile Dysfunction
- Gastro-esophageal reflux disease (GERD)
Weight loss efforts may also be affected if apnea events are left untreated. During apnea, metabolic regulatory hormones that control metabolism are out of sync.
The two hormones thought to be associated with untreated sleep apnea include ghrelin and leptin. Ghrelin, an appetite stimulant, is found in higher levels in patients with OSA. Leptin levels, a hormone that signals satiety to the brain, is inhibited during sleep deprivation caused by sleep apnea events. Untreated OSA is also associated with glucose intolerance and insulin resistance.
Successful oral appliance users get a follow-up sleep test if advised to confirm effectiveness. Without objective data the patient may, unnecessarily, remain sub-optimally treated.
The only way to determine full effectiveness of the device is through a sleep test with the device inserted. Currently, moderate and severe apnea patients would benefit most from a follow-up sleep test. Mild apnea patients may also be recommended to have a follow-up depending on the details of their original diagnosis.
There are several different types of sleep testing available. These may include home sleep tests (HST) or polysomnography sleep lab testing (PSG). Which test is recommended by your medical provider depends on many factors such as original severity, other medical conditions present, as well as medical insurance reimbursement guidelines.
Sleep lab testing polysomnography (PSG) offers a more complete picture of how the device is working in a variety of positions, and can allow for adjustments during the test so as to find the most effective therapeutic position setting of the adjustable oral device.
The HST or home testing offers a more comfortable setting for some patients as they are able to sleep in their own bed and environment. Home sleep testing although not as informative as a polysomnography, is increasingly being used for apnea evaluations.
Other reasons a sleep test may be recommended for oral device users:
Follow-up sleep testing by sleep physicians should also be considered for oral appliance patients who develop recurrent symptoms which may include daytime sleepiness or poor sleep quality. Substantial weight changes (higher or lower), or other new diagnoses of comorbidities relevant to OSA would be circumstances in which a patient may also benefit from an oral appliance sleep test.
Mintz, S. S., & Kovacs, R. (2018). The use of oral appliances in obstructive sleep apnea: a retrospective cohort study spanning 14 years of private practice experience. Sleep and Breathing, 22(2), 541-546.
Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D. (2015). Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of Clinical Sleep Medicine, 11(07), 773-827.
Serra‐Torres, S., Bellot‐Arcís, C., Montiel‐Company, J. M., Marco‐Algarra, J., & Almerich‐Silla, J. M. (2016). Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: a systematic review. The Laryngoscope, 126(2), 507-514.
Sutherland, K., Takaya, H., Qian, J., Petocz, P., Ng, A. T., & Cistulli, P. A. (2015). Oral appliance treatment response and polysomnographic phenotypes of obstructive sleep apnea. Journal of Clinical Sleep Medicine, 11(08), 861-868.