Special Article 1, Issue 7.3

Oral Appliance Therapy Should be Prescribed as a First-Line Therapy for OSA during the COVID-19 Pandemic


David Schwartz, DDS1; Nancy Addy, DDS2; Mitchell Levine, DMD3; Harold Smith, DDS4

1North Shore Family Dentistry, Skokie, IL; 2Snoring and Sleep Apnea Dental Treatment Center, Leawood, KS; 3Department of Orthodontics, University of Tennessee Health Science Center, Memphis, Tennessee; 4Dental Sleep Medicine of Indiana, Indianapolis, Indiana

It is the position of the American Academy of Dental Sleep Medicine (AADSM) that oral appliance therapy (OAT) should be prescribed as a first-line therapy for the treatment of obstructive sleep apnea (OSA) during the COVID-19 pandemic.
This recommendation is being made based on the fol­lowing information:

  • The American Academy of Sleep Medicine (AASM) has indicated that PAP therapy poten­tially exposes individuals, especially those in proximity to the patient, to increased risk of trans­mission of COVID-19.1
  • A number of studies have found evidence that COVID-19 can remain suspended in the air in aerosol particles.2
  • It is unknown whether it is possible for patients to be re-infected from re-using PAP tubing, fil­ters, and/or masks.
  • There have been reported shortages of distilled water and other supplies necessary for optimal use of PAP machines.
  • Oral appliances do not generate aerosols and can be easily disinfected by patients to kill the COVID-19 virus. 

According to the AADSM and AASM clinical prac­tice guideline, oral appliances should be prescribed for adult patients who prefer alternate therapy to PAP.3 During this pandemic, it is reasonable to assume that patients would prefer a therapy that both treats their OSA and does not increase the risk of COVID-19 transmission.
Oral appliance therapy is an effective treatment for OSA3 without increased risks for transmitting COVID-19. Patients who prefer OAT may be more likely to adhere to treatment, if they are confident that their therapy is not put­ting those in their household at an increased risk for COVID-19 exposure.


Schwartz D, Addy N, Levine M, Smith H. Oral appliance therapy should be prescribed as a first-line therapy for OSA during the COVID-19 pandemic. J Dent Sleep Med. 2020;7(3).



  1. COVID-19: FAQs for Sleep Clinicians. https://aasm.org/covid-19-resources/covid-19-faq/. Accessed May 8, 2020.
  2. Liu, Y., Ning, Z., Chen, Y. et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature (2020). https://doi.org/10.1038/s41586-020-2271-3
  3. Ramar K, Dort LC, et al. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015 An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline. J Dent Sleep Med. 2015;2(3). doi:10.15331/jdsm.4868


Submitted in final revised form May 14, 2020.
Address correspondence to: David Schwartz, DDS; Email: dschwartz@aadsm.org


All authors are members of the AADSM Board of Directors Executive Committee. Dr. Schwartz is a consultant of ResMed and has conducted lectures and speaking engagements for SomnoMed and ProSomnus Sleep Technologies.