Endo-buccal orthoses represent an alternative to the reference treatment of obstructive sleep apnea-hypopnea syndrome (OSA), continuous positive pressure by nasal mask (CPAP).
These are mostly devices that position the lower jaw or mandible forward.
The impact of this mandibular advancement is twofold:
Firstly, it produces an advancement of the tongue, preventing the base of the tongue from obstructing the passage of air;
secondly, it puts back under tension all the walls of the pharynx which, in subjects predisposed to apnea or snoring, have a tendency to vibrate and to collapse, thus reducing or completely obstructing the air passage.
The effectiveness on snoring is real about nine times out of ten.
For OSA, nearly two out of three patients can be considered to respond very favorably to treatment.
For the remaining third, the response is insufficient to make the orthosis an alternative treatment to permanent CPAP.
Wearing mandibular advancement braces can cause tooth or gum sensitivity, salivation disorders, and painful tension in the joints or muscles of the jaw.
These problems rarely contraindicate the continuation of the treatment and depend largely on the conditions of implementation. The French National Authority for Health (HAS) specifies that the orthosis must be prescribed, like CPAP, by a sleep specialist. It must be performed by a practitioner with skills concerning both sleep and dysfunctions of the manducatory apparatus.
This therapy is simple, reversible and of moderate cost compared to CPAP; however, it is not possible at this time to predict the effectiveness of the device before its implementation.
Obstructive sleep apnea syndrome (OSA) is an extremely common sleep disorder, affecting 4 to 7% of the adult population.
What is obstructive sleep apnea syndrome?
Obstructive sleep apnea is characterized by the repetitive occurrence, during sleep, of complete respiratory obstructions (apnea) or partial obstructions (hypopnea) of the upper airways. This obstruction is due to a relaxation of the soft tissues which provoke a collapse at the level of the pharynx. Apnea is a cessation of airflow lasting more than 10 seconds.
How does sleep apnea manifest itself?
These apneas and hypopneas will very often provoke micro-awakenings limiting the time of recuperative sleep (slow wave sleep and REM sleep). There is no typical profile of the apneic patient, however anatomical and lifestyle factors can increase the risk.
What are the factors that promote apnea?
Among the anatomical factors that favor these phenomena of partial or complete obstruction, there is an elongated uvula and a thick soft palate.
How does lifestyle influence sleep apnea?
The lifestyle can also influence the evolution of the syndrome, as well as being overweight, smoking, and drinking alcohol in the evening are all factors that favor OSA. In fact, weight gain, alcohol and tobacco decrease the tone of the pharyngeal tissues during the night and therefore favor respiratory obstructions.
What are the symptoms of apnea?
The most common symptoms are:
- Snoring, produced by the vibration of the soft palate and the soft tissues of the pharynx.
- Breathing stops during the night, reported by the spouse.
- Hyper sleepiness and fatigue during the day, nocturnal polyuria, morning headaches.
What are the consequences of apnea?
The most common consequences associated with OSA are:
- Cardiovascular problems
- High blood pressure
- Behavioural problems
- Road and work accidents
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