Recently intra- and extraoral devices are increasingly used in
order to treat obstructive sleep apnea (OSA) and snoring. We examined
the value of some devices according to the literature and our own
results. PATIENTS AND METHODS: The mandibular advancing devices aim at
increasing upper airway diameter. The active part of the tongue
extending device (SnorEx) is a stamp connected to a piston which exerts
pressure at the base of the tongue causing its forward displacement; we
studied 23 patients. The principle of an optically stimulating system
("eye-cover", Snore-Stop) consists of a microphone and light diods
which are integrated in the eye-cover. After detecting acoustic signals
(for example snoring) optical stimuli are generated in front of the
eyes, which are thought to induce arousals causing a change of body
position and the reduction of the snoring and apneas; we measured 24
patients. The principle of the tongue-retainer (Snore-Master) is the
fixation of the tongue in a ventral position, which is thought to
enlarge the mesopharyngeal area; we studied 14 patients.
Stop Snoring Products
The nose plaster (Breathe-Right) contains an elastic spine
that pulls the alae nasi cranial. This manipulation is thought to
increase the diameter of the nostril and reduce the airway resistance.
We measured 30 patients with obstructive sleep apnea and 20 snoring
subjects without obstructive sleep apnea. RESULTS: Regarding the
mandibular advancing due to different appliance designs and study
protocols variable success rates have been documented. In patients with
mild to moderate obstructive sleep apnea a reduction of the sleep
related breathing disorder could be shown. Non compliance (NC) to the
tongue extending device was 75% (17/23). Non-compliance-patients were
characterized by unacceptable local-side-effects of the prosthesis,
lacking improvement of symptoms and of the respiratory disturbance
index. Both tongue-retainer and -extensor are characterized by a high
incidence of local side effects. Neither the eye-cover nor the nose
plaster could improve the severity of obstructive sleep apnoe or
snoring. In contrast to another study we could not show a significant
effect of the tongue-retainer.
Snoring Stop
CONCLUSIONS: Neither the nose plaster nor the optical
stimulating device influenced the degree of obstructive sleep apnea and
snoring. There are conflicting data regarding the tongue retainer. The
high rate of non-compliant subjects and the low efficacy of the tongue
extending prosthesis precludes large-scale use of this treatment
modality in patients with obstructive sleep apnoe and snoring. In
selected individuals suffering from a mild to moderate degree of
obstructive sleep apnea with CPAP-inefficiency and -incompliance the
mandibular advancing principle may be an therapeutic alternative to
CPAP.
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