U.S. Army Sleep Apnea Research Suggests Adjustable Oral Appliances are a Good First-Line Treatment Option

Patients with mild to moderate obstructive sleep apnea (OSA) may consider adjustable oral appliances (OAs) as an effective first-line treatment, according to two studies conducted by sleep medicine specialists from Walter Reed National Military Medical Center. (WRNMMC) in Bethesda, Md.

FORT KNOX, KYThe retrospective, peer-reviewed studies, published in the December 2011 issue of CHEST, the official journal of the American College of Chest Physicians, and in the current issue of the Journal of Clinical Sleep Medicine (JCSM), the official journal of the American Academy of Sleep Medicine, provide findings on OAs from the largest patient populations studied to date. The studies found that adjustable OAs are nearly as effective as continuous positive airway pressure (CPAP) treatment for patients with a mild form of OSA and are more effective than fixed oral appliances, particularly in patients with moderate to severe OSA.

"Historically, CPAP has been the primary treatment for OSA, but only half of patients tolerate this therapy, which requires wearing a face mask hooked to a machine each night," said Lt. Col. Christopher Lettieri, M.D., one of the studies' authors, an Army medical director and the chief of sleep medicine in the pulmonary, critical care and sleep medicine department at WRNMMC. "This new data offers a fresh look at adjustable oral appliances as an initial treatment for OSA in both the military and civilian sectors." Eighteen million Americans, or 4 percent of men and 2 percent of women, suffer from sleep apnea, which can cause daytime sleepiness and has been linked to high blood pressure, heart attack, and stroke.

The military is interested in the potential of adjustable OAs, also called mandibular advancement devices, as alternatives to CPAP systems since some active duty service members deploy to austere environments where electricity needed to run CPAP machines is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service.

"Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing Soldiers to travel to remote areas as needed," said Lettieri.

The study in CHEST, titled "Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome," evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Results were measured by the apnea-hypopnea index (AHI) score, used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypoapnea) of breathing that last for at least 10 seconds per hour of sleep. Researchers found that a significantly higher percentage of patients using an adjustable OA experienced successful reduction of their AHI score to below five apneic events per hour in this study compared to past reports (62.3 percent versus 54 percent).

In the JCSM study, "Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea," patients were treated with either adjustable or fixed OAs and a sleep evaluation was conducted before and during treatment with the devices. Patients using adjustable OAs had a greater reduction in obstructive events (AHI), revealing that adjustable OAs had a greater efficacy than fixed devices (57.2 percent vs. 46.9 percent) among this patient cohort.

A total of 497 patients were prescribed adjustable OAs in the CHEST study and 602 patients in the JCSM study. The studies included patients who participated in an overnight sleep study at the sleep disorders center at Walter Reed National Military Medical Center.

Aaron B. Holley, M.D., Anita A. Shah, D.O., Nathalie Paolino, D.O., and Arn H. Eliasson, M.D., also participated in the studies.

The U.S. Army offers two sleep medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education at Walter Reed National Military Medical Center and San Antonio Military Medical Center.

About the U.S. Army Medical Department
One of the largest health care networks in the world, Army Health Care offers more than 90 professional health care career paths – more than any other military service. The U.S. Army's F. Edward Hebert Armed Forces Health Professions Scholarship Program is one of the most comprehensive health scholarships available today, and covers the complete cost of tuition, school fees and books, a monthly stipend of more than $2,000, as well as a $20,000 signing bonus for select areas of practice. Practicing physicians and health professionals can join the Army Reserve at any time in their career – up to age 60. For more information, visit

Source: U.S. Army Medical Department



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