Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review

Sairam Parthasarathy; Najib T Ayas; Richard Bogan; Dennis Hwang; Clete Kushida; Jonathan S Lown; Joseph M Ojile; Imran Patel; Bharati Prasad; David M Rapoport; Patrick Strollo; Oliver M Vanderveken; John Viviano

doi:10.1093/sleepadvances/zpae035

Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review

Sleep Adv. 2024 Jun 14;5(1):zpae035. doi: 10.1093/sleepadvances/zpae035. eCollection 2024.

Authors

Affiliations

¹ Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA.
² Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Department of Psychaiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
⁴ Division of Sleep Medicine, Kaiser Permanente Southern California, Fontana, CA, USA.
⁵ Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
⁶ Delta Sleep Center of Long Island, Commack, NY, USA.
⁷ Clayton Sleep Institute, St. Louis, MO, USA.
⁸ Dental Sleep Service Line, Banner University Medical Center - Tucson, Tucson, AZ, USA.
⁹ Department of Medicine, University of Illinois at Chicago and Jesse Brown VA Medical Center, Chicago, IL, USA.
¹⁰ Mount Sinai Health System Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹¹ Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹² Department of ENT-HNS, Antwerp University Hospital, Edegem, Belgium and Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
¹³ Sleep Disorders Dentistry Research and Learning Center, Mississauga, ON, Canada.

Abstract

This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.

Keywords: adherence; dental; dental appliance; hypoglossal nerve stimulation; implementation science; obstructive sleep apnea; oral appliance; positive airway pressure; sleep; sleep apnea.