Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome.

STUDY OBJECTIVE: This study, by means of a mail survey, quantified the compliance with and side effects of the use of an oral appliance for more than five years in patients with snoring or obstructive sleep apnea. METHODS: A questionnaire was mailed to 544 patients who used an oral appliance for the treatment of snoring or obstructive sleep apnea. RESULTS: Some 46.1% of the patients returned the questionnaire, 37.8% did not, 15% had an invalid address, and 0.9% were deceased. The mean time period between oral appliance insertion and the return date of these surveys was 5.7 +/- 3.5 years. Of the returned sample, 64.1% were wearing their oral appliance (users). There was no significant difference in the baseline and post-titration respiratory disturbance index between the returned and not-returned groups or between patients who had stopped wearing the oral appliance (nonusers) and users. Within the users group, 93.7% used the oral appliance more than 4 nights per week, 100% wore it more than half of each night, and 95% were satisfied with the treatment. The most frequent reasons why patients discontinued wear were uncomfortable (44.4%), had little or no effect (33.6%), or switched to nasal continuous positive airway pressure (23.3%). Snoring was satisfactorily controlled in 75.6% of users and in 43.2% of nonusers. Side effects, such as dry mouth and tooth and/or jaw discomfort, were more frequent and more severe in the nonusers (P <.05). With oral appliance usage, both users and nonusers reported an increase in temporomandibular joint symptoms, but there was no difference in the degree of change. CONCLUSIONS: Subjects who were compliant with oral appliance therapy reported long periods of use and adequate control of snoring.