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Can An Oral Sleep Apnea Appliance Be Used For Severe Obstructive Sleep Apnea?

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SleepDent +0 points · 16 days ago Original Poster Sleep Commentator

I am a dentist specializing in dental sleep medicine. The answer is YES. Initially the appliances were limited to mild and moderate cases. The original FDA approval was limited to mild to moderate obstructive sleep apnea. For medico-legal reasons appliance manufacturers still say their products are for use with mild to moderate OSA. In recent years more and more appliances have been used successfully for severe obstructive sleep apnea. This DOES NOT mean that you can go online and order a do-it-yourself cheapie appliance and expect to do well. Appliance treatment for severe cases is difficult. You need to find the best sleep dentist in your area and he must use the best appliances currently available. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.

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Sierra +0 points · 16 days ago Sleep Patron

Would it be normal practice to have a sleep study done with the appliance in place to verify that it is effective in reducing severe apnea to acceptable levels lower than 5 for AHI?

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SleepDent +0 points · 16 days ago Original Poster Sleep Commentator

Yes. However, the standard need not be as low as less than five. I will elaborate at a later date.

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SleepDent +0 points · 16 days ago Original Poster Sleep Commentator

I am a dentist specializing in dental sleep medicine. At this point, millions of MADs have been placed. The efficacy of MADs vs CPAP has been tested many times. In a 2019 the AADSM released a position paper called "Just The Facts". Let me summarize the main conclusions. 1. The medical outcomes(the positive health benefit of MADs) were equal in all categories to CPAP for mild, moderate, and SEVERE obstructive sleep apnea.2. CPAP showed superior ability to control breathing problems(reduce AHI) vs. MADs. One would the ask, if CPAP was superior to MADs in reducing apneas and hypopneas, how could the improvements in medical outcomes be the same? The answer is the differential in average wear times. On average, patients use CPAP about four hours per night. On average, patients use MADs for 7-8 hours per night. Therefore, if the MADs are less effective based on lowering AHI, the fact that patients are getting more treatment per night just about evens out the differential in efficacy .I know that this is a difficult concept to wrap your head around. Even some sleep physicians have trouble with it. But facts are facts. A.B. Luisi, D.M.D., The Naples Center For Dental Sleep Medicine.

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Sierra +0 points · 16 days ago Sleep Patron

I never thought of that, as I use my CPAP every minute of the time I sleep, and have been doing so for over 4 years or so.

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SleepDent +0 points · 16 days ago Original Poster Sleep Commentator

That is precisely the point, Sierra. Anyone reading some of the astounding posts that you have so generously provided to this forum over the years can tell that you are smart, disciplined, and organized. Your results are not typical. Only about fifty percent of the patients on CPAP continue to use it long term. Of course, the "failures" are the ones that I generally see. In about eighty percent of the cases, these people will succeed with an MAD. Anybody who cannot make a go of CPAP should be offered the alternative of an oral appliance consultation (and Inspire), but many sleep physicians do not bother to do so. A.B. Luisi, D.M.D.. The Naples Center For Dental Sleep Medicine.

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