Risk of Aggravation of Sleep Apnea with Occlusal Splint

Occlusal splint modifies the space between the dental arches and may reduce the space for the tongue. Consequently, occlusal splints may alter respiratory parameters during sleep. Objectives: This pilot study was designed to assess the influence of an occlusal splint on respiratory parameters during the sleep of mild to moderate apneic patients. Methods: A group of 10 patients with a history of snoring, aged 31 to 59 years, were included in the study following one night of polygraphic recording for sleep apnea diagnosis. All patients presented snoring and > 5 apnea-hypopnea per hour of sleep (AHI). The second night of recording established baseline data in the sleep laboratory (baseline night). Patients then wore the occlusal splint at home for 7 nights and slept with the splint in the laboratory for their third night of recording (splint night). The following variables were analyzed under blind conditions: total sleep time, sleep efficiency, number of awakenings per night, number of micro-arousals per hour of sleep, AHI and percentage of sleep time with snoring. Apnea is considered light with an AHI between 5-15, moderate between 15-30 and severe over 30. Statistical analyses were done with paired t tests and Wilcoxon signed-rank tests. Results: The average AHI was similar during both baseline and splint nights (p = 0.22). However, 4 patients moved to a more severe apnea diagnosis category with the splint. AHI was increased by > 50% in half of the patients. The percentage of sleeping time with snoring increased by 40% with the splint (p = 0.04). Conclusion: The use of an occlusal splint in apneic patients is associated with a risk of aggravation of respiratory disturbances. It may therefore be relevant for dentists to question patients about snoring and sleep apnea when recommending an occlusal splint. Supported by Canadian CIHR.