Clinical Question

Can an oral appliance decrease snoring, improve quality of life, and decrease daytime sleepiness with mild to moderate obstructive sleep apnea?

Bottom Line

An oral appliance does not improve daytime sleepiness or other measures of a good night's sleep. It does, however, decrease apnea scores, snoring, and restless legs. Although not studied, these improvements may be valuable for bed partners who sleep each night enduring patients' lower limb restlessness and breathing irregularities ranging from loud snoring to silence until breathing resumes. (Level of Evidence = 1b)

Synopsis

The Swedish researchers evaluated the effectiveness of an oral appliance in 96 patients with snoring, daytime sleepiness, and mild to moderate obstructive sleep apnea (apneahypopnea index < 30). The appliance, worn at night, holds the patient's jaw forward to maintain a patent airway. The patients were assigned, using concealed allocation, to receive a custom-fitted oral appliance or a placebo appliance that did not affect the jaw placement. The patients were not told of their treatment assignment, although an Internet search could bring up a picture of the appliance for curious patients. Nonetheless, there was no difference in daytime sleepiness (using the Epworth score) between the two groups after four months of treatment. Similarly, the appliance did not improve measures of sleepiness, sleep resistance, quality of life, or functional outcomes of sleep (all measures of the results of sleep). However, snoring, symptoms of restless legs, and the measure of obstructive sleep apnea were improved. These results, although not part of the study, may be valuable for bed partners.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government Allocation: Concealed

Setting: Outpatient (specialty)

Reference: MarklundMCarlbergBForsgrenLOlssonTStenlundHFranklinKAOral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med2015; 175( 8): 1278– 1285.