Doctors combine CPAP treatment with oral appliance therapy

American Academy of Dental Sleep Medicine
Thursday, October 6, 2011

Doctors recommend continuous positive airway pressure (CPAP) as the gold standard of sleep apnea treatment. But 25 to 50 percent of patients do not use the treatment on a regular basis because they can’t tolerate the pressure produced by CPAP. To increase compliance and effectiveness of CPAP, some doctors are combining CPAP treatment with oral appliance therapy.

Research in the journal Sleep and Breathing shows that combination therapy normalized breathing disturbances in sleep apnea patients who were otherwise intolerant to CPAP. When CPAP was used with an oral appliance, patients were able to tolerate their treatment better than CPAP by itself.

Typically, the two treatments are given separately. Oral appliances are fitted by dentists trained in dental sleep medicine. These devices fit like sports mouth guards and move the jaw and tongue forward to open the airway. Oral appliances are most effective with mild to moderate sleep apnea patients.

This study included 10 OSA patients who didn’t tolerate CPAP. They were using oral appliance therapy but still experiencing pauses in breath during sleep. The patients were taken off oral appliance therapy for one week. They then wore CPAP and an oral appliance together for three nights. Oxygen levels were recorded during a sleep study and patients took the Epworth Sleepiness Scale.

Results show that the oral appliance/CPAP combination was well tolerated by all participants. The number of times patients stopped breathing per hour of sleep was reduced from 11 times per hour to three times per hour after combination therapy.

Before treatment, the average sleepiness score was 12. After oral appliance therapy, their average score was reduced to 9. After combination treatment, the score was further reduced to 7. This decrease shows that they had more energy during the day due to combination therapy.


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