Snoring and Obstructive Sleep Apnea (osa) Are Caused in Part by Repetitive Dynamic Obstruc- Tion of the Oropharyngeal

SNORING AND OBSTRUCTIVE SLEEP APNEA (OSA) ARE CAUSED IN PART BY REPETITIVE DYNAMIC OBSTRUCTION OF THE OROPHARYNGEAL AIRWAY. There is growing epidemiological and experimental evidence that OSA, and to a lesser degree snoring, are associated with a wide variety of adverse health outcomes.1, 2 OSA is considered one of several potentially treatable contributors to systemic hypertension, and has been associated with coronary artery disease, stroke, congestive heart failure, atrial fibrillation, increased motor vehicle accident rate, sleepiness, impaired quality of life, and increased mortality. Although several epidemiologic studies suggested a relationship between snoring and hypertension, cardiovascular disease, and cerebrovascular disease, most of these studies were not able to discern the difference between primary snoring and patients with a mild variant of OSA. Nevertheless, snoring represents an important social problem, and contributes to impaired sleep quality of the bed partners of those who snore.3 Oral appliances are increasingly used as a treatment modality for patients with OSA. In 1995, the American Academy of Sleep Medicine (AASM, formerly the American Sleep Disorders Association) published a position paper on the clinical use of oral appliances in the treatment of snoring and obstructive sleep apnea. The paper presented clinical guidelines developed by the Standards of Practice Committee (SPC) of the AASM, based upon Level V evidence (Table 1). Since publication of the practice guidelines, the scientific literature regarding oral appliances has matured and expanded significantly.4 For these reasons, the following new and updated recommendations were developed regarding the use oral appliances in the treatment of snoring and OSA. The purpose of this practice parameter paper is to reissue, modify and, if necessary, replace recommendations for the use of oral appliances in the treatment of snoring and OSA based on the scientific literature published since 1995. Recommendations are based on the accompanying review paper produced by a Task Force established by the Standards of Practice Committee.4 RecPractice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005