It is estimated that up to 25% of the population and nearly one billion people worldwide suffer from a nighttime chronic breathing disease called obstructive sleep apnea. Less than 20% have ever been diagnosed or treated. When we fall asleep, our tongue can fall backwards and partially or completely obstruct our airway. Age, gender, BMI, neck size, large tongues or small jaws, and daytime drowsiness are common predictors or risk factors. This can result in everything from snoring to various stages of sleep apnea. Obstructive Stage 1 or mild Sleep Apnea (OSA) is characterized by 5-15 events per hour. Stage 2 or moderate has 15-340 and stage 3 or severe OSA has more than 30. To be an event, there must be a measured reduction in airflow and oxygen levels of the blood that causes a person to wake up and take a better breath. You would not wake up fully, just enough to take in more air. Snoring and OSA usually are related but you can have one without the other. OSA does not really cause hypertension, heart attack, stroke, diabetes, depression of COPD, but it is instrumental in making all those other diseases much worse. A patient with OSA is 23 times more likely to have a heart attack and 4 times more likely to suffer a stroke. Patients were 5 times more likely to die of COVID during 2020 if they had OSA. This chronic breathing disorder is one of the deadliest contributors to a shortened life span.
First what are the most common treatment options?
Two Extremes
Although positional therapy (sleeping on your side of face instead of back) and various surgical solution are available, the former, rarely is effective enough alone and the latter is far more invasive. Neuro stimulation surgery places a pacemaker sized device under your chest was, has small wires running under the skin to your neck and electrodes deliver a mild current to improve muscle tone and reduce the apnea events. The results a good but not great and the cost is well above $30,000. No mask, no hose just sleep, should have said and some surgery, anesthesia and a narrow range of patients who are candidates. Upper and lower jaw surgery that advances the arches forward is very effective and almost always solves the problem. It is a very invasive surgery, often with some paresthesia and a change in your facial esthetics. Trimming the tissue at the back of your throat and tonsillectomies work well in kids, are less predictable in adults and can offer some improvement.
Positive Airway Pressure Devices
Traditionally, patients who show more than 5 poor breathing events per hour after taking a sleep test (home or lab) were prescribed a CPAP. A mild positive airway pressure is maintained through a combination of machine, mask, and hose to keep the airway open while you sleep. This treatment works nearly 100% of the time…IF, the patient wears the device. Although CPAP works very well, the literature reports average use around 50% of the time. Insurance payable compliance is defined as 4.5 hours per night and 5 nights out of 7…which is around half the available sleep time. So, 50% use,50% of the time is NOT as good a pathway for healthy outcomes.
Custom Mandibular Advancement Devices
Traditional oral appliances solutions, prescribed by a physician and fitted by a dentist, do not work as well as PAP therapy, but are much easier wear. Traditional OAs worked 50-60% of the time, slightly better if you do not include severe sleep apnea. Patients typically wear them 90% of the time. They can be hard to keep clean, sometime become uncomfortable and there are minor but common side effect just like CPAP has. These solutions, in various forms and configurations have been used for over 30 years with modest success.
NEW Precision Mandibular Advancement Devices
Modern precision OAs that are designed and fabricated using artificial intelligence, CAD CAM, and robotic manufacturing are an incredibly easy and effective solution today.. The results are incredibly impressive. A recent Journal of Clinical Sleep Medicine articles reported 94% efficacy for mild and moderate apneics and 81% if you include severe patients. That is on par with and comparable to CPAP results and perhaps more importantly, patients will wear them. Compliance is 90% and the newer precision devices are smaller, require less does and are designed to cause significantly fewer side effects.
How Does This Shift Happen?
Historically, physicians have not been strong supporters of mandibular advancement oral appliance treatment. Inconsistent results. frequent side effects, and poor communication with sleep doctors have resulted in only 5% of prescribed treatments for various CPAP machines. Precision devices and qualified dentists trained by the American Academy of Dental Sleep Medicine have change the landscape. Oral appliance solutions no longer must have metal parts, straps, old fashioned plastics, or printed nylon materials. Today, AI designed, robotically manufactured precision devices made from the safest and most modern medical grade materials have grown to become the patient preferred therapy for obstructive sleep apnea. The joint guidelines from the American Academy Dental Sleep Medicine and the American Academy of Sleep Medicine allow for the use of mandibular advancement devices for mild and moderate obstructive sleep apnea patients and for severe sufferers who cannot tolerate CPAP. Precision oral appliance solutions are creating a shift in the prescribing frequency of sleep physicians. These devices which are covered by virtually all medical insurance, is also a much more cost-effective solution. Patient preferred, physicians shifting and payers saving, the perfect formula for successful medical outcomes in treating obstructive sleep apnea today.
