What happens with your non-compliant CPAP users?
Your clinic may be the best in the UK, achieving an unheard of 80% CPAP compliance rate, but that still leaves a significant number of patients who simply cannot get used to positive airway pressure therapy as a means of treatment for their obstructive sleep apnoea. The largest UK sleep clinics send up to 100 patients home with a CPAP machine and mask so statistically, 20 patients would struggle to cope with the mask and air pump. Do you refer these ill people for painful, expensive and low-succes surgery? Or do you send them home, without any form of treatment?
Offer your non-compliant patients oral appliance therapy!
With the UK launch of the SomnoDent MAS, it is now finally possible for sleep clinics to offer a reliable and efficient CPAP alternative. Suitable for snorers, sufferers of upper airway resistance syndrome as well as obstructive sleep apnoea patients, the SomnoDent Mandibular Advancement Splint (MAS) is a saviour for those unable to make a success of positive airway pressure therapy. In fact, oral appliance therapy (OAT) with the SomnoDent MAS works so well, in leading countries like Germany and the U.S. this unique splint is even offered as a first line treatment for mild-to-moderate obstructive sleep apnoea. And if a severe apneic cannot tolerate CPAP, the SomnoDent MAS may go a long way to reducing the patient's AHI and daytime sleepiness.
Is oral appliance therapy recognised by the N.I.C.E.?
Despite the lack of an appraisal of oral appliance therapy for the treatment of obstructive sleep apnoea, in March 2008 the N.I.C.E. stated the following in their CPAP appraisal:
The alternatives to CPAP are lifestyle management, dental devices and surgery. Lifestyle management involves helping people to lose weight, stop smoking and/or decrease alcohol consumption. Dental devices are designed to keep the upper airway open during sleep. The efficacy of dental devices has been established in clinical trials, but these devices are traditionally viewed as a treatment option only for mild and moderate OSAHS. [...]
The Assessment Group identified six RCTs that compared the effects on daytime sleepiness (ESS score) of CPAP and dental devices. A meta-analysis of these studies did not identify a statistically significant difference between the two treatments (weighted mean difference in ESS score -0.9; 95% CI -2.1 to 0.4). [...]
There was no statistically significant difference between CPAP and dental devices when the results from two studies reporting scores on the Functional Outcomes of Sleep Questionnaire and two studies reporting the Sleep Apnoea Quality of Life Index were pooled. [...]
The Committee noted that most of the available RCT evidence did not identify a statistically significant reduction in daytime sleepiness for CPAP compared with dental devices.
One of the official bodies advising the review committee was the British Society of Dental Sleep Medicine. They work closely with the British Sleep Society as well as the British Thoracic Society to make sure standards of dental sleep medicine in the UK are as high as those in other leading countries.
In which cases is oral appliance therapy suitable?
The world-wide standards have been set by the German Society of Dental Sleep Medicine when they published a position paper, which has been accepted by the American and European Academy of Dental Sleep Medicine as the leading paper in this field. It was published in 2007 in the renowned journal Sleep Breath. You can read this position paper (PDF) here. In short, according to these experts, oral appliance therapy through mandibular advancement splints can be used in the following cases.
- As an initial treatment for
- Primary snoring
- Upper airway resistance syndrome
- Mild to moderate obstructive sleep apnoea (AHI up to about 25/h) with minor clinical symptoms with a sufficient number of retaining teeth and a BMI of up to 30.
- In cases of sleep-related breathing disorders (SRDB) with an approximate AHI of over 25/h, Mandibular Advancement Devices (MADs) can be used as an alternative after a previous therapeutic trial with nCPAP.
- Regardless of SRDB severity in patients with CPAP failure and CPAP noncompliance.
In short, quality custom-fit appliances such as the SomnoDent MAS can be recommended to patients who just snore or have mild-to-moderate obstructive sleep apnoea as well as patients with severe sleep apnoea who have failed with CPAP.
How does compliance and acceptance compare with CPAP?
One of the major advances offered by the SomnoDent oral sleep appliance is improved patient compliance. The ability to freely open the mouth, speak, and drink with the splint fitted, is a big step forward in this type of medical treatment. The following industry-leading acceptance and compliance rates were found in an internal research report:
- 96% of patients with proven OSA stated they would like to continue to use the SomnoDent oral sleep appliance
- 91% of patients reported substantial improvement in sleep quality with the SomnoDent oral sleep appliance
- 87.5% of patients reported nightly use of the SomnoDent oral sleep appliance
How does the patient benefit from a splint compared to CPAP?
Please refer to the page titled "A CPAP Alternative" for a direct comparison.
Is the SomnoDent MAS available on the NHS?
Unfortunately, no (not yet). The SomnoDent MAS is only available to private patients who are ready to invest their own money. Health insurers sporadically cover oral appliance therapy but most patients pay for the splint outright themselves.
Do we need a dentist at the sleep clinic?
It would be handy if we trained a dentist in your hospital but it is not necessary. There is a network of dentists ready to fit SomnoDent splints so there is bound to be one within a reasonable distance form your patient. Simply provide the patient or dentist with a confirmation of the diagnosis and your patient is ready to be fitted this unique splint.
Can we get any brochures to hand out to our patients?
Yes, see "Contact Us" and get in touch with us at Intus Healthcare. We can send you patient leaflets explaining everything they need to know to consider a SomnoDent MAS.
Is there an independent organisation who can tell us about OAT?
Yes, please contact the British Society of Dental Sleep Medicine. They work closely with the more familiar BSS and BTS and they can tell you all about oral appliance therapy. |
