NEW YORK (Reuters Health) - A dental appliance worn at night appears to be more successful in treating obstructive sleep apnea (OSA) than surgery, according to a study conducted in Sweden.

People with OSA stop breathing dozens of times each night, causing them to gasp for breath. The condition is conservatively estimated to affect up to 4% of middle-aged Americans, and is particularly common among obese people.

Sleep apnea has been linked to daytime sleepiness, as well as an increased risk of high blood pressure and cardiovascular disease.

The Swedish study found the success rate in patients with OSA who wore the dental appliance was 81%, compared to 53% in OSA patients who had surgery. However, after 4 years, many patients were no longer wearing the device when they slept. Lead author Dr. Marie-Louise Walker-Engstrom of Central Hospital in Vasteras, Sweden, and colleagues report their findings in the March issue of the medical journal Chest.

There are several treatments available for sleep apnea, including continuous positive airway pressure, in which a person wears a facemask that introduces a gentle stream of air into their airways to keep them open during the night.

Surgery called uvulopalatopharyngoplasty (UPPP), in which tissue from the back of the throat is removed, may also be performed to treat OSA. This is the main surgical treatment for people with mild to moderate OSA, the study authors note.

The current study compared UPPP to a dental appliance worn at night that pushes the lower jaw slightly forward, increasing airflow in and out of the throat.

In the study, 95 men diagnosed with mild to moderate OSA were split into two groups. One group underwent UPPP surgery and the other patients were fitted with the dental appliance. All of the men went through a battery of sleep tests that evaluated their OSA before treatment and again 1 and 4 years after treatment.

"The success rate in the dental appliance group was 81%, which was significantly higher than in the UPPP group, 53%," Walker-Engstrom and colleagues write.

However, only 62% of the patients in the dental appliance group were still wearing the device when they slept after 4 years. But the researchers found that the dental appliance had few adverse effects on the jaw and throat, and the number of adjustments and repairs of the appliances over time was moderate.

"This long-term controlled trial...represents a major step forward in catching treatment options for OSA up to the recent progress made in detecting the disease," writes Dr. Scott E. Eveloff of the Kansas City Pulmonary Clinic in Missouri, in an accompanying editorial. He notes that there is no "gold standard" for OSA treatment, but a number of effective options that can be tailored to the individual patient.

SOURCE: Chest 2002;121:674-677, 739-746.

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