open access
메뉴ISSN : 0376-4672
Sleep related breathing disorders (SRBDs) are a spectrum of diseases characterized by difficulties in airflow during sleep. Central sleep apnea, obstructive sleep apnea (OSA), sleep-related hypoventilation, and hypoxemia disorder are included in this disease entity. OSA is known to be the most common SRBDs and studies show its significant correlation with general health issues including hypertension, arrhythmia, diabetes, and metabolic syndrome. The relationship between cardiovascular risk and OSA is especially significant with systemic inflammation, intermittent hypoxia, and increased oxidative stress considered as the underlying mechanism. Previous studies show that oral appliance treatment for OSA has a positive impact on lowering blood pressure and such an effect is non-inferior to that of continuous positive airway pressure therapy. More recent studies also support the favorable effect of oral appliance treatment for OSA patients in the aspect of endocrine, psychologic disorders, and cognitive function. Furthermore oral appliance treatment for OSA is known to improve the overall quality of life and daytime sleepiness levels of the patient. The dentist who is experienced in dental sleep medicine can easily identify patients with the risk of OSA and provide appropriate treatment. The dentist should play an important part in the diagnosis and treatment of OSA which is inevitably connected to the well-being of the patient and better treatment results for various conditions. So the objective of this article is to assist dental professionals in gaining knowledge and insight of the systemic effects of oral appliance treatment for OSA.
1. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76
2. Kim J, In K, Kim J, You S, Kang K, Shim J, Lee S, Lee J, Lee S, Park C, Shin C. Prevalence of sleep-disordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med. 2004;170(10):1108-13
3. White DP. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172(11):1363-70
4. Susarla SM, Thomas RJ, Abramson ZR, Kaban LB. Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. Int J Oral Maxillofac Surg. 2010;39(12):1149-59
5. McDaid C, Durée KH, Griffin SC, Weatherly HL, Stradling JR, Davies RJ, Sculpher MJ, Westwood ME. A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome. Sleep Med Rev. 2009;13(6):427–36
6. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;(1):CD001106
7. Bazzano LA, Khan Z, Reynolds K, He J. Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension. 2007;50(2):417–23
8. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli PA. Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sel ep Med. 2014;10(2):215-27
9. Ilea A, Timuș D, Höpken J, Andrei V, Băbțan AM, Petrescu NB, Câmpian RS, Boșca AB, Șovrea AS, Negucioiu M, Mesaros AȘ. Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development. Cranio. 2019:1-12
10. Grote L, Hedner J, Grunstein R, Kraiczi H. Therapy with nCPAP:incomplete elimination of Sleep Related Breathing Disorder. Eur Respir J. 2000;16(5):921-7
11. Dieltjens M, Vanderveken O. Oral Appliances in Obstructive Sleep Apnea. Healthcare (Basel). 2019;7(4):141
12. Vanderveken OM, Dieltjens M, Wouters K, De Backer WA, Van de Heyning PH, Braem MJ. Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing. Thorax. 2013;68(1):91-6
13. Dieltjens M, Braem MJ, Vroegop AVMT, Wouters K, Verbraecken JA, De Backer WA, Van de Heyning PH, Vanderveken OM. Objectively measured vs self-reported compliance during oral appliance therapy for sleep-disordered breathing. Chest. 2013;144(5):1495-1502
14. Sutherland K, Phillips CL, Cistulli PA. Efficacy versus Effectiveness in the Treatment of Obstructive Sleep Apnea: CPAP and Oral Appliances. J Dent Sel ep Med. 2015;2:175–181
15. Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and metaanalysis. J Clin Sel ep Med 2009;5(6):573–81
16. Peker Y, Carlson J, Hedner J. Increased incidence of coronary artery disease in sleep apnoea: a long-term follow-up. Eur Respir J. 2006;28(3):596-602
17. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM. Sleep disordered breathing and mortality:eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8
18. Coughlin SR, Mawdsley L, Mugarza JA, Calverley PM, Wilding JP. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J. 2004;25(9):735-41
19. Yaffe K, Laffan AM, Harrison SL, Redline S, Spira AP, Ensrud KE, Ancoli-Israel S, Stone KL. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA. 2011;306(6):613–9
20. Jordan AS, McSharry DG, Malhorta A. Adult obstructive sleep apnoea. Lancet. 2014;383(9918):736-47
21. Worsnop CJ, Naughton MT, Barter CE, Morgan TO, Anderson AI, Pierce RJ. The prevalence of obstructive sleep apnea in hypertensives. Am J Respir Crit Care Med 1998;157(1):111- 5
22. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 2005;172(11):1447-51
23. Parish JM, Adam T, Facchiano L. Relationship of metabolic syndrome and obstructive sleep apnea. J Clin Sleep Med. 2007;3(5):467-72
24. Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Sunyer FX, Darcey V, Kuna ST; Sleep AHEAD Research Group. Obstructive sleep apnea among obese patients with type 2 diabetes. Diabetes Care. 2009;32(6):1017-9
25. Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181(5):507-13
26. Punjabi NM, Ahmed MM, Polotsky VY, Beamer BA, O'Donnell CP. Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol. 2003;136(2-3):167-78
27. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165(5):670-6
28. Tasali E, Leproult R, Ehrmann DA, Van Cauter E. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci U S A. 2008;105(3):1044-9
29. Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2018;38:39-49
30. Ohayon MM. The effects of breathing-related sleep disorders on mood disturbances in the general population. J Clin Psychiatry. 2003;64(10):1195-200
31. Jackson ML, Tolson J, Bartlett D, Berlowitz DJ, Varma P, Barnes M. Clinical depression in untreated obstructive sleep apnea: examining predictors and a meta-analysis of prevalence rates. Sleep Med. 2019;62:22-28
32. Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK. Effect of oral appliances on blood pressure in obstructive sleep apnea:a systematic review and meta-analysis. J Clin Sleep Med. 2013;9(2):165-74
33. Cook NR, Cohen J, Hebert PR, Taylor JO, Hennekens CH. Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med. 1995;155(7):701–9
34. de Vries GE, Wijkstra PJ, Houwerzijl EJ, Kerstjens HAM, Hoekema A. Cardiovascular effects of oral appliance therapy in obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev. 2018;40:55-68
35. Baslas V, Chand P, Jurel SK, Tripathi S, Arya D, Tripathi S, Singh BP, Dubey A. A Pilot Study to Determine the Effect of Three Months of Oral Appliance Therapy using a Mandibular Advancement Device on HbA1c in Subjects with Type 2 Diabetes Mellitus and Obstructive Sleep Apnea. J Prosthodont. 2019;28(3):271-275
36. Harsch IA, Konturek PC, Koebnick C, Kuehnlein PP, Fuchs FS, Pour Schahin S, Wiest GH, Hahn EG, Lohmann T, Ficker JH. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J. 2003;22(2):251-7
37. Pamidi S, Tasali E. Obstructive sleep apnea and type 2 diabetes: is there a link? Front Neurol. 2012;3:126
38. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, Marks GB, Cistulli PA. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013;187(8):879-87
39. Tegelberg A, Wilhelmsson B, Erixon-Lindroth N, Lindström LH. Improved cognitive functions after treatment with an oral appliance in obstructive sleep apnea. Nat Sci Selep. 2012;4:89-96
40. Naismith SL, Winter VR, Hickie IB, Cistulli PA. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea:a randomized controlled trial. J Clin Selep Med. 2005;1(4):374-80
41. Beebe DW, Groesz L, Wells C, Nichols A, McGee K. The neuropsychological effects of obstructive sleep apnea: a metaanalysis of norm-referenced and case-controlled data. Sleep. 2003;26(3):298-307
42. Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10(5):772-85
43. Park JW, Mehta S, Fastlicht S, Lowe AA, Almeida FR. Changes in headache characteristics with oral appliance treatment for obstructive sleep apnea. Sci Rep. 2021;11(1):2568