Custom-Made Oral Appliances for the Treatment of
Obstructive Sleep Apnea: Outcomes in Thai Patients
Rachareeya Suksangeam MD¹, Wish Banhiran MD¹, Phawin Keskool MD¹, Wattanachai Chotinaiwatarakul MD²,
Cheerasook Chongkolwatana MD¹, Paraya Assanasen MD¹, Somsak Mitrirattanakul DDS, PhD³,
Pimnaraporn Putongkam DDS⁴
Affiliation :
¹ Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ² Division of Neurology, Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ³ Department of Masticator science, Faculty of Dentistry, Mahidol University, Bangkok, Thailand ⁴ Dental Division, Siriraj Hospital, Bangkok, Thailand
Objective : To evaluate the outcomes of custom-made oral appliances (OAs) for the treatment of obstructive sleep apnea (OSA) in Thai patients.
Materials and Methods : A retrospective review of polysomnography (PSG) results and relevant information, including patient characteristics, visual analog scale (VAS) of sleep-associated symptoms, and Epworth Sleepiness Scale (ESS) of patients treated with an OA between January 2010 and January 2018 was done at Siriraj Hospital, Thailand. Inclusion criteria were OSA patients aged 18 years or older who underwent diagnostic and therapeutic PSG with a custom-made OA. Exclusion criteria were patients who were lost to follow-up or had incomplete PSG data.
Results : Sixty-seven OSA patients were recruited. The median apnea-hypopnea index (AHI) was significantly decreased from 16.5 (11.5, 27.8) to 5.1 (2.8, 11.3) events per hour (p<0.001) and the median minimal oxygen saturation increased from 82.0 (77.0, 86.0) to 87.0 (80.0, 90.0) with OA treatment (p<0.001). ESS scores decreased from 9 (6, 13) to 7 (4, 9) (p<0.001) and the VAS of snoring loudness and frequency as rated by family members or bed partners decreased from 6 (4, 7.5) to 3.3 (2, 5) and from 5.5 (3.2, 7.6) to 3.4 (2, 5.3), respectively (p<0.001). Forty-one patients (61%) had a 50% reduction of AHI, and an AHI of less than 15 events per hour after treatment, which were considered good responses. Common adverse effects of the treatment included temporomandibular joint discomfort, dry mouth, excessive salivation, gingival pain, and toothache, but these occurred to only a mild-to-moderate degree and were tolerable.
Conclusion : Custom-made OA is an effective alternative treatment for OSA in selected Thai patients, particularly for those with a mild-to-moderate degree.
Received 3 August 2020 | Revised 31 October 2020 | Accepted 2 November 2020
doi.org/10.35755/jmedassocthai.2021.04.11696
Keywords :
Custom-made oral appliance, Obstructive sleep apnea, OA, OSA, Thai
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