Oral appliance therapy for snoring and sleep apnea: preliminary report on 86 patients fitted with an anterior mandibular positioning device, the Silencer.

There has been a great deal of interest recently in snoring and obstructive sleep apnea (OSA) by both dental and medical professions, as well as the media. Oral appliance therapy has been recognized by many sleep disorder specialists as the primary treatment of choice for snoring and mild to moderate OSA. Continuous positive airway pressure (CPAP) is the gold standard treatment for severe OSA, with oral appliance therapy reserved for CPAP failures. CPAP therapy has a compliance rate of 50 to 70%. The author has had experience with anterior mandibular positioning devices, in particular, Dr. Wayne Halstrom's Silencer for approximately 2 years. All patients are thoroughly investigated to include a polysomnogram (PSG) to assess the degree of snoring and OSA. Patients who are suitable candidates for oral appliance therapy are offered a temporary appliance with a follow-up PSG prior to fitting with the permanent appliance or initially with a more comfortable, custom-fitted permanent appliance. In either case, attempts are made to convince the patients of the necessity for a follow-up PSG to evaluate the efficacy of the device. The results, as well as potential harmful side effects and complications, are presented and are compared with the results of other recent studies.