What are the AASM guidelines for the use of oral appliances (OAs) in obstructive sleep apnea (OSA)?

Updated: Sep 15, 2020
  • Author: Himanshu Wickramasinghe, MD, MBBS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The American Academy of Sleep Medicine (AASM) has published practice parameters and a review of the use of OAs in persons with OSA. [186, 187] These parameters include the following recommendations:

  • The presence or absence of OSA must be determined before treatment with OAs is started in order to identify patients at risk because of complications of sleep apnea and to provide a baseline to establish the effectiveness of subsequent treatment.

  • For patients with OSA, the desired outcome of treatment includes resolution of the clinical signs and symptoms of OSA and normalization of the patient’s AHI and oxyhemoglobin saturation.

  • Although OA therapy is not as effective as CPAP, OAs are indicated for use in patients with mild-to-moderate OSA who prefer OAs to CPAP, those whose condition does not respond to CPAP, those who are not appropriate candidates for CPAP, and those in whom attempted CPAP or behavioral measures (eg, weight loss, changing sleeping positions) fail.

  • Patients with severe OSA should receive an initial trial of nasal CPAP because CPAP is more effective than OA therapy. UA surgery may also supersede the use of OAs in patients for whom these operations are predicted to be highly effective in treating sleep apnea.

  • To ensure satisfactory therapeutic benefit from OAs, patients with OSA should undergo PSG or an attended cardiorespiratory (type 3) sleep study with the OA in place after final adjustment of fit is performed.


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