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Oral appliance (OA) treatment has long been used as measure against snoring and OSA. It has therefore been deemed important to identify better tolerated treatment options 4. Despite its well-known benefits, adherence is generally poor and its use is often felt bothersome with little evidence on how its utility might be improved 8. Continuous positive airway pressure (CPAP) is a common treatment for OSA on the basis of its efficacy using objective measures 7. If their OSA is left untreated, the risk for all-cause mortality increases 3- 6. Patients suffering from moderate and severe OSA exhibit a range of comorbidities including cardiovascular disease, metabolic syndrome as well as depression. Similar frequencies have been found in a large Norwegian population-based study where the estimated prevalence of OSA was 16% for AHI ≥ 5 and 8% for AHI ≥ 15 2. The prevalence varied depending on the cut-off value of apnoea hypopnoea index (AHI), and for ≥5 events h −1 and ≥15/h, the prevalence was 14% and 6%, respectively 1. When using strict diagnostic criteria (full, attended nocturnal polysomnography), a recent systematic review reported prevalence among community-screened adult patients to range from 2% to 14%.
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Obstructive sleep apnoea (OSA) is a common disorder, although prevalence varies widely in the literature. OA treatment of patients non-adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated. Low oxygen saturation (SpO 2 nadir) had a high predictive value for OA treatment failure. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). The overall treatment success rate was 75%. If there was a ≤ 50% reduction in baseline AHI at the follow-up, the treatment was considered as a failure. A successful OA treatment outcome was based on polygraphy at the follow-up and divided into three groups: 1 = AHI 50% reduction in baseline AHI and 3. Average time between baseline polygraphy and follow-up was 12 months. Nocturnal respiratory polygraphic recordings were performed at baseline and follow-up. Ten of the participants (8♶%) were lost to follow-up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28-90). During 2007-2013, 116 patients with moderate ( n = 82) and severe ( n = 34) OSA non-adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Single-player and co-op multiplayer modes are available, as well as competitive multiplayer deathmatches.The aim of this retrospective study was to evaluate the effect of individually adjusted custom-made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non-adherent to continuous positive airway pressure (CPAP) therapy. You can choose from a range of weapons, from the traditional revolvers, rocket launcher, sniper rifle, shotgun, minigun and submachine guns to bizarre innovations like a bomb-carrying parrot.
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