Moving Forward When CPAP Fails

This chapter discusses the role of oral appliance (OA) therapy for treating obstructive sleep apnea (OSA). Positive airway pressure (PAP) therapy is often the first-line treatment for OSA, but the average PAP adherence is approximately 50%. OA is a good alternative to PAP therapy that can be combined with other conservative options, such as weight loss and positional therapy. Many patients with OSA who cannot tolerate PAP therapy may be able to be managed by OA. Short-term side effects of OA device usage for OSA include tooth pain, gum soreness/gingival irritation, muscle soreness, myofascial pain, excessive salivation, dryness, and abnormal occlusion. OA adherence for OSA treatment is greater than that observed for PAP and shows comparable improvement in subjective sleepiness. PAP therapy continues to show greater improvement in the apnea/hypopnea and hypoxia index.