Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015: An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline
Open accessAbstract
Introduction Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.Methods The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.Recommendations 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE).Conclusions The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations.
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Oral appliances can provide efficacious and effective treatment for obstructive sleep apnea, including in obese patients.
“Oral appliances (OAs) can provide both efficacious and effective treatment for patients with OSA, including those who are obese.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [809]
The Introduction says oral appliances offer effective therapy for many patients with OSA, and section 4.2b recommends considering them for adults who cannot tolerate CPAP or prefer an alternative. The Results do not establish effectiveness specifically in obese patients; they describe conflicting evidence on whether body mass index predicts treatment success. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe AHI decrease with tirzepatide is clinically relevant, as it exceeds the American Academy of Sleep Medicine clinical significance threshold of 15 or more events per hour and the proposed 50% improvement in AHI.
“This change is considered clinically relevant; the American Academy of Sleep Medicine defines the clinical significance threshold for the AHI as 15 or more events per hour, 25 and other sources have proposed a 50% improvement in AHI as clinically relevant. 26,27”
From Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (2024) · cites this paper as [26]
Citation 25 is attached to the asserted AASM threshold of a 15-or-more-events-per-hour AHI decrease; the 50% criterion is attributed to other sources. The guideline’s §4.2.1 reports AHI reductions with oral appliances, but no passage found in searches for the clinical-significance threshold or 15 events per hour defines that threshold. It also does not address tirzepatide. (LLM, conf=0.75)
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- Authors
- Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D.
- Affiliations
- Mayo Clinic (US)
- University of Calgary (CA)
- Walter Reed National Military Medical Center (US)
- American Academy of Sleep Medicine (US)
- University of Michigan (US)
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2015-07-15
- Volume
- 11
- Issue
- 7
- Pages
- 773-827
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC4481062
- OpenAlex
- W814012870
- Semantic Scholar
- af4362550110c34bd77c3414efe0ffccfcf036c3
- Cited by
- 915
- References
- 55
- Citations by year
- 2026: 95 · 2025: 96 · 2024: 104 · 2023: 96 · 2022: 92 · 2021: 82 · 2020: 88 · 2019: 81 · 2018: 70 · 2017: 67 · 2016: 34 · 2015: 7 · 2014: 1 · 2013: 1
- FWCI
- 43.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- obstructive sleep apnea, snoring, oral appliance therapy, CPAP intolerance, occlusal changes, treatment efficacy, patient follow-up, clinical guidelines, GRADE evidence assessment, sleep medicine, dental sleep medicine, treatment safety
- MeSH terms
- Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Orthodontic Appliances, Removable, Positive-Pressure Respiration, Severity of Illness Index, Snoring, Orthodontic Appliance Design, Treatment Outcome, Polysomnography, Practice Guidelines as Topic, Mandibular Advancement, Sleep Apnea, Obstructive
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