Management of the obstructive sleep apnoea syndrome: More knowledge required for an optimal choice of treatment modality

In the management of the obstructive sleep apnoea syndrome (OSAS), clinicians may consider various conservative, non-invasive and surgical treatment modalities. Continuous positive airway pressure (CPAP) is regarded as the treatment of choice for, especially, moderate to severe OSAS. However, due to the obtrusive nature of this conservative treatment, especially in mild manifestations of OSAS, the effectiveness of CPAP may be compromised due to poor therapeutic acceptance and adherence. Over the last decade, oral appliance therapy has emerged as an increasingly popular treatment alternative to CPAP. However, due to the methodological limitations of most trials studying this dental treatment modality, the precise indication for oral appliance therapy is still indistinct. In addition, based on the current level of evidence, most surgical interventions in OSAS should generally be reserved for patients with failing CPAP therapy. In order to determine whether the available treatment alternatives are competitive with CPAP, methodologically sound and preferably randomised studies are indicated