SOURCE: Hamoda MM, et al. Chest 2018;153:544-553.

Continuous positive airway pressure (CPAP) has been the traditional recommended intervention for obstructive sleep apnea for more than three decades. Unfortunately, limitations on the ultimate application of CPAP to treat obstructive sleep apnea include expense and (for many) poor tolerability. Among the alternative interventions are oral appliances, typically divided into two categories: tools that stabilize the tongue in a forward position, and tools that stabilize the mandible in a forward position. The recently FDA-approved device that employs an electrical curren to activate oropharyngeal musculature with improved tongue muscular tone is not included in this review.

Using technical metrics for success, such as degree of improvement of the apnea-hypopnea index, CPAP has been shown to outperform oral appliances. On the other hand, patient-centered outcomes (sleepiness, quality of life, and driving performance) have been found to be equally well-improved by oral appliances as CPAP. Perhaps the most important bottom line is that many patients find compliance with CPAP difficult, and the limited data on oral devices suggest significantly greater compliance with them than with CPAP.

Aside from efficacy and tolerability, cost may be the ultimate deal maker (or breaker). Mandibular advancement devices that may be created at home by the patient cost as little as $30. While dental experts may offer more complex, sophisticated oral appliances, success attained with simple do-it-yourself home kits is quite appealing for many. Fortunately, the diversity of treatment options currently available should stimulate optimism that the consequences of obstructive sleep apnea can be improved successfully in most patients.