Oral Appliances for the treatment of snoring and OSA
The definition of an oral appliance according to the American Association of Dental Sleep Medicine is as follows:
The purpose of an oral appliance is to treat obstructive sleep apnea (OSA), primary snoring, and associated symptoms. Oral appliances are intended to decrease the frequency and/or duration of apneas, hypopneas, respiratory effort related arousals (RERAs) and/or snoring events. Oral appliances have been demonstrated to improve nocturnal oxygenation as well as the adverse health and social consequences of OSA and snoring. Oral appliances are indicated for patients with mild to moderate OSA and primary snoring. Oral appliances are accepted therapy for patients with severe OSA who do not respond to, or are unable or unwilling to tolerate, positive airway pressure (PAP) therapies. Although oral appliances are typically used as a stand-alone therapy, they can serve as an adjunct to PAP therapy and/or other treatment modalities for the management of OSA.
The function of an oral appliance is to protrude and help stabilise the mandible to maintain a patent upper airway during sleep. Current literature provides robust evidence that custom, adjustable, dual-arch mandibular advancement oral appliances are highly efficacious for the treatment of snoring and mild-moderate OSA1.
Though less efficacious than CPAP for improving AHI in moderate-severe OSA, several recent studies found that oral appliances and CPAP were equally effective at improving daytime somnolence, hypertension, neurocognitive function, quality of life indices, and cardiovascular mortality.
Though little objective adherence data is available, numerous crossover studies have demonstrated oral appliance self-reported adherence to be superior to CPAP.
Combination therapy may hold promise for those patients who are insufficiently responsive to a monotherapy.
* 1 Consensus Conference Participants: Steven C. Scherr, DDS, Moderator1 *; Leslie C. Dort, DDS, Moderator2 *; Fernanda R. Almeida, DDS, PhD3 ; Kathleen M. Bennett, DDS4 ; Norman T. Blumenstock, DDS5 ; B. Gail Demko, DMD6 ; Gregory K. Essick, DDS, PhD7 *; Sheri G. Katz, DDS8 ; Paul M. McLornan, DDS9 ; Katherine S. Phillips, DDS10*; Ronald S. Prehn, DDS11*; Robert R. Rogers, DMD12; Thomas G. Schell, DMD13; Rose D. Sheats, DMD14*; Flavia P. Sreshta, DDS15; Journal of Dental Sleep Medicine Vol 1, No 1 2014. Definition of an Effective Oral Appliance for the Treatment of OSA and Snoring.
Guidelines for the use of Oral Appliances have been published by the Board of Australasian Sleep Association.
Nasal Congestion and the treatment of OSA
There is building clinical evidence that nasal congestion is a risk factor in sleep disordered breathing.
- Nasal obstruction due to allergic rhinitis associated with OSAS (McNicholas WT 1982, Lavie P 1981)
- Experimentally induced nasal obstruction induced episodes of apnoea and episodes of arousal from sleep (Zwillich C 1981, Lavie 1983)
- A significant longitudinal population study reported 3-fold increase in the incidence of snoring and daytime sleepiness in volunteers with self-reported nocturnal nasal congestion (Young T 2001).
- Nasal obstruction has been shown to be a risk factor for sleep apnea syndrome, studying 541 unselected snorers (Lofaso et al. Eur Respir J 2000)
- Open-mouth breathing during sleep is a risk factor for OSA and is associated with increased disease severity and upper airway collapsibility (Kim et al. .Eur Arch Otorhinolaryngol. 2011)
- Mouth breathing is associated with up to 2.5 times higher total resistance (M.F. Fitzpatrick et al. Eur Respir J 2003;22:827-832)
This significant issue is not addressed by existing oral appliances and CPAP therapy.
Nasal congestion or obstruction are commonly cited as a complication and reason for non-adherence to both oral appliance therapy and CPAP (Sugiura T 2007, Zeng et al SLEEP 2008).
The Oventus Treatment Platform and patented airway technology are helping to address this challenge. Further studies are underway to validate the Oventus Airway Technology’s impact on efficacy and compliance for patients with nasal obstruction.
Innovation moving medical technology forward
Oventus was developed by the company founder and Clinical Director, Dr Chris Hart. As a sleep disorder sufferer himself, Dr Hart was anxious to find an oral breathing therapy that was better than the current market alternatives.
Using his expertise as a professional dentist, he thought he could devise an oral appliance himself that would better increase airflow to the lungs and bypasses multiple sites of obstruction including the nose, tongue and soft palate.
In an industry first, Dr Hart partnered with Australia’s peak scientific body, the Commonwealth Scientific and Industrial Research Organisation (CSIRO) in 2013 to design a bespoke mouthguard, using innovative titanium 3D-printing technology.
The result was the O2VentTM Mono
With a unique separate airway incorporated into a patented design, the O2Vent Mono devices deliver air to the back of the mouth, whilst alleviating multiple sites of resistance or obstruction, including the nose, soft palate and tongue.
The O2VentTM Mono was the first in a series of devices developed by Oventus, employing the Oventus Airway Technology. The customised devices may be particularly beneficial for the many people with nasal obstructions, who consequently tend to breathe mainly through their mouths during sleep.
No matter what style of device you prefer to use for your patients, the Oventus Airway Technology can be incorporated into it. Oventus will continue to launch a range of devices utilising different titration mechanisms – all incorporating the unique airway design and all with the ability for out-of-the-box CPAP connectivity, which is well advanced in product development.
The Oventus Medical Quality System is fully accredited according to ISO 13485 international standards.
How the O2VentTM works
1
If there is reduced flow through the nasal airway or a soft palate obstruction occurs, air can be drawn into the front of the device while lips are closed around it to maintain an oral seal
2
Air passes through to the back of the device in an enclosed airway
3
The device advances the lower mandible to stabilise jaw position, bringing the tongue forward and opening the airway
For a more detailed explanation of how the unique design allows for breathing through the device, bypassing obstruction in the nose which can contribute to snoring and sleep apnoea, simply watch this video.
The Oventus Treatment Platform
The Unique O2VentTM Oral Devices offer three key benefits
1
Comfort
The O2VentTM custom mouthguard devices are custom made for you to provide a perfect fit. Made from a titanium core inserted into soft mouthguards, these lightweight sleep apnoea treatment devices weigh only 35 grams (1.23 oz). The streamlined design has enabled an airway to be built into the device whilst not obstructing the tongue.
2
Portability
The lightweight device has no mask or complicated machines attached, so it is easy to take with you as you travel, and store during the day when not in use.
3
Oventus Airway Technology — The Second Nose
Each O2VentTM device has an airway incorporated into it about the size of a healthy human nostril. Air enters the mouth and is delivered to the back of the throat, so you can breathe through the device while maintaining an oral seal, to avoid a dry mouth or sore throat.
Clinical trial results with O2VentTM Mono
100% of patients experienced significant improvement in snoring using the O2VentTM
82% of patients experienced complete elimination of snoring using O2VentTM
76% of patients decreased their Apnea-Hypopnea Index (AHI) by more than 50%**
Lavery D, Hart C et al. Safety and Efficacy of a Novel Oral Appliance in the Treatment of Obstructive Sleep Apnea. Journal of Dental Sleep Medicine Vol.4 No.3 July 2017
Compliance monitoring
As well as therapeutic advantages, the Oventus Airway Technology has the ability to facilitate diagnosis and monitoring for compliance and effectiveness. Currently in testing is an inbuilt form of compliance monitoring and an attachment that allows a Level III home sleep test to be done any time, anywhere without wires hanging off the patient and feeding data directly to an Oventus App and online treatment monitoring portal.
Future developments — exciting opportunities for dentists
The patented airway in the O2VentTM enables exciting opportunities for dentists to offer alternative treatments to their patients.
If you would like to be kept informed of future product releases, please register your interest here.
Education in Dental Sleep Medicine
Dentists practising in the field of Dental Sleep Medicine should follow the recommendations for practice protocol as reported in the most recent American Academy of Sleep Medicine publication 'Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances.'
Oventus encourages dentists to undertake regular appropriate training and educational activities to ensure their knowledge is up to date in this area. Further details of accredited and approved courses are available from the Australasian Sleep Association.
Dentists interested in practising in this field are encouraged to become associate members of the ASA and to attend and participate in the annual scientific meetings. These conferences will offer postgraduate introductory courses in Oral Sleep Medicine and present current scientific content in all sleep disorders.
Upcoming events and training
Oventus Medical are proud to support major Sleep Medicine events. Events, training and webinars for 2019 coming soon!
Resources
If you would like to request patient brochures or a demonstration device please register here.
For further reading on oral appliances and related subjects, please explore the links below:
Dental Appliance Therapy for the treatment of Sleep Disordered Breathing, Endorsed by Board of Australasian Sleep Association July 2010
Oral Appliance Position Statement – Australasian Sleep Association, 11 June 2013
Oral Appliances for Sleep Apnoea