Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: An update for 2015

Abstract

Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientifi c literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modifi ed Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefi t of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the fi nal guideline recommendations. Recommendations: 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualifi ed dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualifi ed dentists provide oversight- rather than no follow-up-of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dentalrelated side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confi rm treatment effi cacy, rather than conduct follow-up without sleep testing, for patients fi tted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualifi ed dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic offi ce visits- as opposed to no follow-up-with a qualifi ed dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline refl ects the state of knowledge at the time of publication and will require updates if new evidence warrants signifi cant changes to the current recommendations.