Therapeutic Strategies
Oral Appliances
Somnofit appliance
Oral appliances, such as mandibular advancement devices (MADs), are an alternative treatment option for patients with mild to moderate OSA who are unable or unwilling to use CPAP. Although less effective than CPAP in reducing AHI, MADs have been shown to improve subjective sleepiness, quality of life, and cardiovascular outcomes.
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Video showing clinical stages for one type of custom-made MAD.
Mandibular Advancement:
MADs reposition the mandible and tongue forward, increasing the retrolingual and retropalatal airway dimensions. This forward displacement of the mandible reduces airway collapsibility and resistance, preventing upper airway obstruction during sleep.
Stabilization of the Hyoid Bone:
Oral appliances may also contribute to the stabilization of the hyoid bone, which helps maintain the patency of the upper airway. By stabilizing the hyoid bone, MADs prevent the posterior displacement of the tongue and pharyngeal structures during sleep.
Neuromuscular Effects:
Emerging evidence suggests that oral appliances may enhance upper airway muscle tone and responsiveness, further contributing to airway patency. Studies have shown that MADs can increase genioglossus muscle activity, which plays a crucial role in maintaining airway stability.