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Who is a good candidate for oral appliance therapy for OSA?

Posted on January 5th, 2021

Many people try CPAP therapy when they’re first diagnosed with obstructive sleep apnea (OSA). If they have trouble using the CPAP, they become candidates for oral appliance therapy. Until now, CPAP has been the first line of therapy for all patients, but a new study suggests that the underlying cause of OSA determines whether CPAP or oral appliances are a better treatment for the condition.

A group of Australian researchers published a study in Annals of the American Thoracic Society that discussed the common traits of patients who are good candidates for oral appliance therapy instead of CPAP as a first-line OSA treatment. This is important work since most insurers will only fund CPAP as first-line therapy.

Many patients must prove that CPAP doesn’t work for them before their insurers will qualify them for an oral appliance. This can result in treatment delays and long-term damage to their health if CPAP is not the best treatment for their condition.

Traits of an oral appliance patient

The researchers looked at sleep studies for a group of patients and found that the patients who did better on oral appliances than on CPAP had…

  • Upper airway collapsibility outside of the ‘severe’ range
  • Weak lower muscle compensation for apneas
  • Lower loop gain
  • A higher arousal threshold (sounder sleepers)
  • And a lower ventilatory response to apneas

Patients with these traits were found to be “highly responsive” to oral appliance therapy.   The severity of OSA and obesity were not factors in how well a patient responded to CPAP versus an oral appliance.

For the patients who had these markers, a custom oral appliance gave them a 73% reduction in AHI, and, after treatment, they averaged only 8 apneas per hour. That means the appliance took patients from moderate to severe OSA down to mild OSA. This was a huge improvement. 

Adding oral appliance therapy to your dental practice

In the study, it turned out that 61% of patients could benefit from oral appliance therapy.  However, patients generally have to go through a dental office with sleep medicine services to receive this therapy. One roadblock to receiving therapy in many communities is a lack of dental practices that can provide the necessary expertise.

If you’re a dentist who would like to add this important, life-saving service to your dental practice, the Sleep Mastery Bootcamp will give you the tools you need to give patients access to sleep apnea screening and treatment in your practice. This hybrid course format uses both online and live, virtual sessions to help you turn your office into a resource for patients with sleep issues.

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website:

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