Oral appliance therapy in obstructive sleep apnea: Therapeutic effects and side effects

Obstructive sleep apnea (OSA) is characterized by repetitive obstructions of the upper airway that are often related to oxygen desaturations and arousals from sleep. The prevalence of OSA varies from 9% to 38% in the adult population. Excessive daytime sleepiness, lack of concentration, and snoring are frequently reported complaints. Furthermore, patients with untreated OSA are at increased risk of impaired quality of life, hypertension, stroke, heart failure, diabetes, and involvement in car accidents. Therefore, ineffective treatment of OSA has severe consequences and is associated with high costs, both for the individual and for society. Continuous positive airway pressure (CPAP) has been proposed as the most effective treatment for severe OSA patients. Mandibular advancement devices (MADs) are considered as a primary treatment option in mild and moderate OSA patients and in severe OSA patients who do not tolerate CPAP.
The studies in this thesis have contributed to increasing our insight into the effects and side effects of MADs as well as those of CPAP and occlusal stabilization splints in OSA patient. The effects on psychological distress and sleep-related problems did not differ between the MAD and CPAP groups; and the presence of clinical signs and symptoms of temporomandibular pain was similar for the MAD group and the CPAP group. A worsening of OSA was observed in some patients when increasing the jaw gape with an MAD without protrusion or upon inserting an occlusal stabilization splint.