Oral appliances in the treatment of obstructive sleep apnea syndrome

Obstructive sleep apnea (OSA) is the most common respiratory sleep disorder in clinical practice and it occurs as a result of decreased muscle tone of pharyngeal musculature. Sleep apnea/hypopnea syndrome is described as the occurrence of a minimum of five interruptions in breathing and/or the decrease in ventilation during one hour of sleeping (apnea/hypopnea index-AHI) with the existence of daytime and night-time difficulties. Multimodal treatment of OSA includes:1) hygienic-dietary regimen and lifestyle, 2) surgical approach to upper airways, 3) use of oral appliances (OA) and 4) noninvasive ventilation with continuous positive airway pressure - CPAP. "Gold standard" in sleep apnea syndrome treatment especially in severe forms of OSA is CPAP. A therapy of choice for mild-to-moderate OSA and an alternative treatment for CPAP intolerance are oral appliances. A mandibular protrusion splint and a tongue-retaining device are in use. Simplicity of handling, portability, lack of noise, independence from a power source and lower cost bring potential advantages over CPAP. By increasing the volume of upper airways the number of obstructive breathing events and arousals is being significantly reduced, and arterial oxygen saturation is being improved, particularly in the mild-to-moderate OSA range. It has been confirmed that intraoral devices decrease daytime sleepiness and arterial blood pressure. They are not recommended in severe periodontopathy. A close cooperation and surveillance by medical doctor and dentist is required, from the correct choice and drafting of oral appliance, through initial patient's accommodation to treatment, to long-term follow-up of therapeutic effect in sleep medicine laboratories.