**10. Oral appliance therapy**

to decrease the number of obstructive episodes and severity and the collapse tendency and

Weight loss, quitting smoking and alcohol, changing sleep positions and head posture, and avoidance of central nervous system depressors may be beneficial for some patients. Weight loss may decrease OSA symptoms by reducing the size of the tongue and soft palate. Quitting alcohol and depressor drugs prevents the relaxation of upper airway muscles. Alteration of sleeping position can prevent the tongue and mandible moving backward and narrowing the

OSA resulted from anatomic obstruction of the upper airway, unsuccessful behavioral therapies, and inability to tolerate CPAP or oral appliances, which are inclusion criteria for surgical treatment. Tracheostomy, tonsillectomy and adenoidectomy, genial advancement with or without hyoid myotomy, uvulopalatopharyngoplasty, laser glossectomy and lingualplasty, maxillomandibular advancement, and epiglottoplasty are the surgical techniques used for

It is a device which has a small air pump connected to either a sealed face or nose mask. The device opens the pharyngeal airway and prevents the soft tissues from collapsing and blocking the airway. It is the gold standard treatment option for moderate to severe OSAS cases, and the success rate is about 75%. However, patient compliance is poor because of the pump noise, the irritation of nasal mucosa because of the airflow to the nose, xerostomia, and poor retention. The patient non-compliance ratio was reported to range from 46 to 83%. The ordinary usage of nCPAP device for 4–6 weeks decreases the volume of the tongue and increases the pharyngeal volume. Inclusion criteria for nCPAP therapy are moderate and severe OSAS patients with AHI score greater than 20, mild OSAS patients with AHI scores between 10 and 20 but has excessive daytime sleepiness and cardiopulmonary or cerebrovascular risks, anatomical-based OSAS patients whose medical health condition is inappropriate to surgical treatment, and mild-to-moderate OSA patients who have failed behavioral modification

airway. The patients are instructed to sleep on their sides rather than their backs.

**9.3. Nasal continuous positive airway pressure (nCPAP) device treatment**

therapy and unable to tolerate oral appliances [1–10, 16, 17].

increase the airway area, blood oxygen saturation, and life quality.

**3.** Use of nasal continuous positive airway pressure device (nCPAP)

Treatment options in OSAS are:

**1.** Behavioral modification

**2.** Surgical treatments

182 Current Approaches in Orthodontics

**4.** Use of oral appliances

**9.2. Surgical treatment**

the treatment of OSAS.

**9.1. Behavioral modification**

Oral appliance treatment was first introduced in the 1980s and is a very effective treatment option for mild-to-moderate OSAS and seven patients with severe OSA who cannot tolerate CPAP or refuse surgical therapy. The American Sleep Disorders Association reported that oral appliance therapy is the primary treatment for patients with mild OSA and a secondary treatment option for moderate to severe OSA. For severe OSA patients, reduction in AHI score occurs, but it cannot turn into the normal range. If the AHI score cannot be decreased to 20, long-term health risks will continue. Oral appliances can be successful if only they are used after the etiological factors are eliminated. Only obstructive sleep apnea can be treated with oral devices; they are not indicated for central and mixed apneas [10–12, 16–21, 23–32].
