Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review.

This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.

Retrospective comparison of the George Gauge™ registration and the sibilant phoneme registration for constructing OSA oral appliances.

Objective: To compare outcomes for appliances manufactured utilizing the George Gauge™ Registration (GGR) and the Sibilant Phoneme Registration (SPR). It was hypothesized that there would be no difference in outcomes.Methods: This study is a retrospective analysis of two groups. Each group consisted of 20 oral appliances manufactured utilizing the GGR and 20 utilizing the SPR.Results: For the two-site data, no difference in outcomes was demonstrated (p = .24). The SPR method required fewer calibrations (p = 5.6 × 10-3) and less jaw movement (p = 3.33 × 10-4). Both bite methods resulted in similarly variable post-AHI scores (p = .52). For the eight-site data, no difference in outcomes was demonstrated (p = .76). The SPR required less movement of the jaw (p = 4.52 × 10-5); however, outcome variance was larger for the SPR (p = .036).Conclusion: The study null hypothesis of no difference in outcomes was supported.Abbreviations: AHI: Apnea-Hypopnea Index; GGR: George Gauge Registration; SPR: Sibilant Phoneme Registration; OSA: Obstructive Sleep Apnea; OA: Oral Appliance; OAT: Oral Appliance Therapy; MA: Mandibular Advancement; VDO: Vertical Dimensional Opening; AADSM: American Academy of Dental Sleep Medicine; ABDSM: American Board of Dental Sleep Medicine; BMI: Body Mass Index.

Assessing orthotic normalization of pharyngeal dynamics.

Airway orthotic therapy, considered mainstream in the treatment of sleep-disordered breathing, has been demonstrated to normalize both structure and function of the pathological airway through manipulation of mandibular posture. Although effective, the literature reports a variable rate of success and no validated candidacy selection protocol. Acoustic reflection has been used to evaluate and document the upper airway and its dynamics with and without an orthotic in place. This paper will discuss the use of acoustic reflection to assess the level of airway normalization resulting from protrusive and vertical repositioning of the mandible and its utility to establish orthotic candidacy, construction, titration, and maintenance parameters. This protocol has potential for use in both medical and dental facilities that treat patients with sleep-disordered breathing.

Acoustic reflection: review and clinical applications for sleep-disordered breathing.

Sleep-disordered breathing (SDB) affects more than 4% of the adult population with an even higher prevalence within high-risk groups. Nasal continuous positive air pressure, although considered the current gold standard treatment for SDB, demonstrates poor patient compliance. Alternative therapies, such as palatal surgeries and airway orthotics, lack validated candidacy selection protocols, resulting in varying success rates. Although much has been published over the last several years regarding the effect of these therapies on the upper airway, no publication has presented an accounting of the use of acoustic reflection (AR) to evaluate airway characteristics pre- and post-treatment with these alternative therapies. This article will review AR and our current knowledge base of the pathological airway characteristics that can be assessed through AR. It will include the advantages, limitations, and potential clinical usefulness of this diagnostic modality in the treatment of patients with SDB.