Effects of Occlusal Stabilization Splints on Obstructive Sleep Apnea: A Randomized Controlled Trial

Aims: To assess the influence of occlusal stabilization splints on sleep-related respiratory variables in obstructive sleep apnea (OSA) patients. Methods: Ten OSA patients (47.3 ± 11.7 years of age) received a stabilization splint in the maxilla. All patients underwent three polysomnographic recordings with their splint in situ, and three recordings without their splint in situ, using a randomized crossover design. Results: Repeated-measures ANOVAs did not yield statistically significant differences in the Apnea-Hypopnea Index (AHI) or in the Epworth Sleepiness Scale (ESS), neither between the three nights without the stabilization splint (AHI: F = 2.757, P = .090; ESS: F = 0.153, P = .860) nor between the nights with the splint in situ (AHI: F = 0.815, P = .458; ESS: F = 0.231, P = .796). However, independent ANOVAs revealed that the mean AHI of the three nights with the stabilization splint in situ (17.4 ± 7.0 events/hour) was significantly higher than that of the nights without the splint in situ (15.9 ± 6.4 events/hour) (F = 7.203, P = .025). The mean increase in AHI with the splint in situ was 1.4 ± 1.7 (95% confidence interval = -1.9-4.7). No difference in ESS was found when both conditions were compared (F = 1.000, P = .343). Conclusion: The use of an occlusal stabilization splint is associated with a risk of aggravation of OSA; however, the effect size was small, which reduces the clinical relevance of the study.

crossover design; obstructive sleep apnea; occlusal stabilization splint; randomized controlled trial; vertical dimension

1. american academy of Orofacial Pain. Orofacial Pain: Guidelines for assessment, Diagnosis, and Management, ed

4. De Leeuw r (ed). chicago: Quintessence, 2008.

2. american academy of Sleep Medicine: international classification of Sleep Disorders. Westchester, iL: american academy of Sleep Medicine, 2005.

3. american academy of Sleep Medicine Task force: Sleep- related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22:667–689.

4. Gagnon Y, Mayer P, Morisson f, rompré PH, Lavigne GJ. aggravation of respiratory disturbances by the use of an occlusal splint in apneic patients: a pilot study. int J Prosthodont 2004;17:447–453.

5. nikolopoulou M, naeije M, aarab G, Hamburger HL, Visscher cM, Lobbezoo f. The effect of raising the bite without mandibular protrusion on obstructive sleep apnea. J Oral rehabil 2011;38:643–647.

6. Kushida ca, Morgenthaler Ti, Littner Mr, et al. american academy of Sleep: Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 2006;29:240–243.

7. aarab G, Lobbezoo f, Hamburger HL, naeije M. Effects of oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. respiration 2011;81:411–419.

8. Johns MW. a new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540–545.

9. Lavigne GJ, rompré PH, Montplaisir JY. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent res 1996;75:546–552.

10. Lobbezoo f, van Selms MK, John MT, et al. Use of the research diagnostic criteria for temporomandibular disorders for multinational research: Translation efforts and reliability assessments in The netherlands. J Orofac Pain 2005;19:301–308.

11. van der Zaag J, Lobbezoo f, Wicks DJ, Visscher cM, Hamburger HL, naeije M. controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism. J Orofac Pain 2005;19:151–158.

12. rechtschaffen a, Kales a. a Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los angeles: UcLa Brain information Service/Brain research institute, 1968.

13. Stradling Jr, crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991;46:85–90.

14. Mosko SS, Dickel MJ, ashurst J. night-to night variability in sleep apnea and sleep-related periodic leg movements in the elderly. Sleep 1988;11:340–348.

15. Bittencourt Lra, Suchecki D, Tufik S. The variability of the apnoea-hypopnoea index. J Sleep res 2001;10:245–251.

16. aarab G, Lobbezoo f, Hamburger HL, naeije M. Variability of the apnoea-hypopnoea index and its consequences for diagnosis and therapy evaluation. respiration 2009;77:32–37.

17. Dao TT, Lavigne GJ. Oral splints: The crutches for temporomandibular disorders and bruxism? crit rev Oral Biol Med 1998;9:345–361.

18. Macedo cr, Silva aB, Machado Ma, Saconato H, Prado Gf. Occlusal splints for treating sleep bruxism [review]. cochrane Database Syst rev 2007;17:D005514.

19. Ettlin Da, Mang H, colombo V, Palla S, Gallo LM. Stereometric assessment of TMJ space variation by occlusal splints. J Dent res 2008;87:877–881.

20. Davies rJ, Stradling Jr. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur respir J 1990;3: 509–514.

21. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. am J respir crit care Med 2002;165:1217–1239.

22. Strobel rJ, rosen rc. Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep 1996;19:104–115.

23. Punjabi nM. The epidemiology of adult obstructive sleep apnea. Proc am Thorac Soc 2008;5:136–143.

24. Malhotra a, Huang Y, fogel r, et al. aging influences on pharyngeal anatomy and physiology: The predisposition to pharyngeal collapse. am J Med 2006;119:72.e9–e14.

25. Eikermann M, Jordan aS, chamberlin nL, et al. The influence of aging on pharyngeal collapsibility during sleep. chest 2007;131:1702–1709.

26. aarab G, Lobbezoo f, Heymans MW, Hamburger HL, naeije M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. respiration 2011;82:162–168.