Cardiologists embrace oral appliances as an alternative treatment to CPAP for sleep apnea

Cardiologists have long recognized that sleep apnea is a leading cause of hypertension (high blood pressure), heart attacks and strokes. Cardiologists have referred patients for sleep studies and CPAP therapy for years. Cardiologists have become disillusioned by the poor compliance with CPAP that has been documented in patients with sleep apnea. The majority of patients with mild apnea as well as moderate and severe sleep apnea reject CPAP in large numbers. A recent study showed 60% of patients abandon CPAP therapy.

Cardiologists who are proponents of sleep apnea treatment are referring more and more patients for oral appliance therapy as an alternative to CPAP. They recognize that CPAP therapy is worthless if it is not used. Oral appliances are considered a first line treatment for mild to moderate sleep apnea. Oral appliance therapy is also an alternative to CPAP for severe sleep apnea when patients do not toleratte CPAP.

THE MAJORITY OF PATIENTS DO NOT TOLERATE CPAP!!! MEDICARE IS NO LONGER COVERING CPAP THERAPY FOR PATIENTS WHO DO NOT USE CPAP ON A REGULAR BASIS. MOST PATIENTS DO NOT USE CPAP ON A REGULAR BASIS.

Cardiologists are more comfortable referring patients for CPAP but have come to realize that patients are much more compliant with oral applainces than CPAP.

This means that patients use their oral appliances to treat their sleep apnea. Cardiologists know this is vital to their patients health. While CPAP may be more effective for some patients it is a total treatment failure for those patients who do not use their CPAP.

In addition to heart attacks and stroke untreated sleep apnea can also cause short term memory loss, lead to drammatic increases n motor vehicle accidents because patients with untreated sleep apnea have slower reaction times than patients who are legally intoxicated. Untreated sleep apnea can increase severity and speed of onset of Alzheimer's and Dementia, is implicated in up to 80% of ADD and ADHD in children, can increase the severity of metabolic problems from diabetes to obesity.

The National Sleep Foundation has declared that oral appliances are a therapy whose time has come!

The American Academy of Sleep Medicine considers oral appliances to be a first line treatment for mild to moderate sleep apnea.

The American Academy of Dental Sleep Medicine has published reports on the success of treating severe sleep apnea with comfortable oral appliances.

MORBIDLY OBESE PATIENTS SHOULD STILL CONSIDER CPAP AS THE TREATMENT OF CHOICE. A RECENT STUDY SHOWED THAT PROPERLY TITRATED ORAL APPLIANCES ARE EQUALLY EFFECTIVE TO CPAP FOR SLEEP APNEA PATIENTS.

THE UNITED STATES GOVERNMENT HAS ENDORSED ORAL APPLIANCES FOR TREATING SLEEP APNEA BY ACCEPTING DENTAL SLEEP MEDICINE FOR COVERAGE UNDER MEDICARE.

THE NEW MEDICARE POLICY ALSO RECOGNIZES THE DISMAL COMPLIANCE RATES OF CPAP WITH NEW MINIMAL USAGE REQUIREMENT FOR CPAP COVERAGE. THIS NEW POLICY WILL BENEFIT EVERYONE AS MANUFACTURERS AND DME'S WORK TO INCREASE COMPLIANCE WITH CPAP.

HYPERTENSION, SLEEP APNEA AND CPAP COMPLIANCE. ORAL APPLIANCES ARE A CPAP ALTERNATIVE.

AN ARTICLE IN CHEST JOURNAL LOOKS AT SLEEP AND HYPERTENSION. According to the August 2010 article in Chest "even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality.". This increase in in Blood pressure "sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension.is related to many types of sleep disorders including restless legs "sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension".

Patients with sleep apneathe article states "observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence."

The problem is that CPAP compliance is poor or non-existent for the majority of patients. Due to the severe problems that can result from untreated sleep apnea more and more concerned and compassionate cardiologists and internists are turning to Oral Appliances and Dental Sleep Medicine as the Best Sleep Apnea Treatment for their patients that do not tolerate CPAP.

There is no question that CPAP therapy is very effective when it is used. There is also no longer a belief that most patients will tolerate CPAP. Because non adherence and non-compliance is the rule not the exception in sleep apnea treatment the question about "What is the Best Sleep Apnea Treatment?" is still open.

Chest. 2010 Aug;138(2):434-43.
Sleep and hypertension.
Calhoun DA, Harding SM.

Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA. dcalhoun@uab.edu
Abstract
Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.

PMID: 20682533 [PubMed - indexed for MEDLINE]PMCID: PMC2913764 [Available on 2011/8/1