Patient Reported Side-Effects of Oral Appliances for Sleep Apnea

Objectives: Untreated obstructive sleep apnea (OSA) is associated with significant morbidity and mortality. Adherence to treatment is a problem with those who begin treatment. Aims: To survey patients given an oral appliance for OSA for the side-effects they experienced with their appliance and reasons they discontinued using their appliance.
Methods: The Ohio State University IRB approved this study. All patients who had received an oral appliance between October 2008 and March 2015 in one university-associated private practice were contacted by phone and asked to respond to a series of questions regarding their appliance.
Results: Of the 242 eligible patients, 112 (46%) responded to the phone call invitation. Eighty-six (77%) reported that they were adherent with their oral appliance therapy and 26 reported that they were no longer using an oral appliance. Females were 35% in the adherent group and 46% in the non-adherent group. In the non-adherent group, 11 of the 26 reported that they were currently using CPAP. Sixty-four adherent patients (74%) reported 1 or more side-effects: 35-jaw pain, 21-bite changes, 13-tooth pain, 9-drooling, and 9-other (3-dry mouth, 3-soft-tissue irritation, 3-sore gums, 1 each of tooth decay, headaches, and TMJ). For those who discontinued appliance therapy, the most common reason(s) given were: 11-discomfort, 7-did not work, 7-bite change, 2-no longer fitting, 2-CPAP, 1-apnea better, 1- lost/broken, 7-other (1 each: headache, broken teeth, choked/constraining, didn’t fit, tooth grinding, gagging, no reason).
The overall appliance adherence rate, 77%, was consistent with reports in the literature. The overall therapy (oral appliance or CPAP) adherence rate was 87%.
Conclusions: Pain/discomfort and bite change were the most common side-effects in appliance adherent and patients who discontinued appliance use.