Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.
Level 1 - systematic review of randomized trials
Clinical practice guideline developed from a systematic literature review using a modified GRADE framework.
PubMed 26094920 · doi:10.5664/jcsm.4858
What was done
A seven-member task force commissioned by the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) conducted a systematic literature review to update the 2006 clinical practice guidelines on oral appliance (OA) therapy. Evidence quality was assessed using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework, and recommendations were assigned strengths (STANDARD or GUIDELINE) based on the balance of clinical benefits versus potential harms.
What was found
The abstract reports no quantitative data or effect sizes. It provides six specific clinical recommendations: 1. Sleep physicians should prescribe OAs over no therapy for adult primary snoring (STANDARD). 2. Qualified dentists should fabricate custom, titratable appliances rather than non-custom devices for adult OSA (GUIDELINE). 3. Sleep physicians should consider OAs over no treatment for adult OSA patients intolerant of CPAP or preferring alternative therapy (STANDARD). 4. Qualified dentists should provide follow-up oversight to monitor and mitigate dental side effects and occlusal changes (GUIDELINE). 5. Sleep physicians should perform follow-up sleep testing to confirm treatment efficacy (GUIDELINE). 6. Patients should undergo routine, periodic follow-up visits with both a sleep physician and a qualified dentist (GUIDELINE).
Why it matters
The document establishes updated, multidisciplinary clinical standards defining the appropriate patient selection for oral appliances in snoring and OSA, while mandating objective sleep testing and ongoing dental surveillance.
Limits
The abstract does not report quantitative outcomes, effect sizes, study counts, or total patient numbers. Long-term adherence, comparative efficacy against CPAP across OSA severity strata, and specific device designs were not detailed in the abstract. Panel recommendations partly rely on consensus trade-offs between benefits and harms.
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- context There is an FDA-approved oral device that treats severe sleep apnea and reduces the Apnea-Hypopnea Index (AHI) to normal levels, putting it into lasting remission.