4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

A Randomized Study

      Study objectives

      To evaluate the effects of treatment with a dental appliance or uvulopalatopharyngoplasty (UPPP) on somnographic variables in patients with mild-to-moderate obstructive sleep apnea (OSA) followed up for 4 years, and compliance and complementary treatment.


      Randomized study.


      Central Hospital, Västerås, Uppsala University, Sweden.


      Ninety-five male patients with confirmed mild-to-moderate OSA (apnea index [AI] > 5 and < 25) were randomized to treatment with a dental appliance or UPPP. Sleep studies were performed before and 1 year and 4 years after intervention. Thirty-two patients in the dental-appliance group and 40 patients in the UPPP group completed the 4-year follow-up.


      The success rate (percentage of patients with at least 50% reduction in AI) in the dental-appliance group was 81%, which was significantly higher than in the UPPP group, 53% (p < 0.05). Normalization (AI < 5 or apnea/hypopnea index < 10) was observed in 63% of the dental-appliance group and 33% of the UPPP group after 4 years. The difference between the groups was significant (p < 0.05). The compliance to use of the dental appliance was 62% at the 4-year follow-up. Thirty patients (75%) in the UPPP group continued without complementary treatment. The dental appliances had few adverse effects on the stomatognathic system, and the number of adjustments and repairs of the appliances over time was moderate. Pronounced complaints of nasopharyngeal regurgitation of fluid and difficulty with swallowing after UPPP were reported by 8% and 10%, respectively.


      The dental-appliance group showed significantly higher success and normalization rates regarding the somnographic variables compared to the UPPP group, but the effectiveness of the dental appliance was partly invalidated by the compliance of 62% at the 4-year follow-up. However, the appliances had few adverse effects on the stomatognathic system and required only moderate adjustments. Use of a dental appliance with regular follow-up can be recommended for long-term treatment of OSA.

      Key words


      AHI (apnea/hypopnea index), AI (apnea index), BMI (body mass index), CPAP (continuous positive airway pressure), CI (confidence interval), ODI (oxygen desaturation index), OSA (obstructive sleep apnea), SI (snoring index), TMJ (temporomandibular joint), UPPP (uvulopalatopharyngoplasty)
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Gislasson T
        • Almqvist M
        • Boman G
        • et al.
        Prevalence of sleep apnoea syndrome among Swedish men: an epidemiological study.
        J Clin Epidemiol. 1988; 41: 571-576
        • Young T
        • Palta M
        • Dempsey J
        • et al.
        The occurrence of sleep-disordered breathing among middle-aged adults.
        N Engl J Med. 1993; 328: 1230-1235
        • Lavie P
        • Herer P
        • Peled R
        • et al.
        Mortality in sleep apnea patients: a multivariate analysis of risk factors.
        Sleep. 1995; 18: 149-157
        • Cheshire K
        • Engleman H
        • Deary I
        • et al.
        Factors impairing daytime performance in patients with sleep apnoea/hypopnea syndrome.
        Arch Intern Med. 1992; 152: 538-541
        • Yamadera W
        Improvement in excessive daytime sleepiness after surgical treatment or obstructive sleep apnoea syndrome.
        Psychiatr Clin Neurosci. 1995; 49: 213-221
        • Lindberg E
        • Janson C
        • Sva¨rdsudd K
        • et al.
        Increased mortality among sleepy snorers: a prospective, population based study.
        Thorax. 1998; 53: 631-637
        • Peker Y
        • Hedner J
        • Kraiczi H
        • et al.
        Respiratory disturbance index: an independent predictor of mortality in coronary artery disease.
        Am J Respir Crit Care. 2000; 162: 81-86
        • He J
        • Kryger MH
        • Zorick FJ
        • et al.
        Mortality and apnea index in obstructive sleep apnea: experience in 385 male patients.
        Chest. 1988; 94: 9-14
        • Svanborg E
        • Larsson H
        Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome.
        Chest. 1993; 104: 340-343
        • Partinen M
        • Jamieson A
        • Guilleminault C
        Long-term outcome for obstructive sleep apnea syndrome patients: mortality.
        Chest. 1988; 94: 1200-1204
        • Lysdahl M
        • Haraldsson P-O
        Long-term survival after uvulopalatopharyngoplasty in nonobese heavy snorers.
        Arch Otolaryngol Head Neck Surg. 2000; 126: 1136-1140
        • Larsson H
        Long-time follow-up after UPPP for obstructive sleep apnea syndrome.
        Acta Otolaryngol (Stockh). 1991; 111: 582-590
        • Larsson H
        • Carlsson-Nordlander B
        • Svanborg E
        Four-year follow-up after uvulopalatopharyngoplasty in 50 unselected patients with obstructive sleep apnea syndrome.
        Laryngoscope. 1994; 104: 1362-1368
        • Jansson C
        • Gislason T
        • Bengtsson H
        Long-term follow-up of patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty.
        Arch Otolaryngol Head Neck Surg. 1997; 123: 257-262
        • Lu S
        • Chang S
        • Shiao G
        Comparison between short-term and long-term post-operative evaluation of sleep apnoea after uvulopalatopharyngoplasty.
        J Laryngol Otology. 1995; 109: 308-312
        • Haavistoo L
        • Suonpa¨a¨ J
        Complications of uvulopalatopharyngoplasty.
        Clin Otolaryngol. 1994; 19: 243-247
        • Sher A
        • Schechtman K
        • Piccirillo J
        The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome: an American Sleep Disorders Association review.
        Sleep. 1996; 19: 156-177
        • Zohhar Y
        • Finkelstein Y
        • Talmi Y
        Uvulopalatopharyngoplasty: evaluation of postoperative complications, sequelae, and results.
        Laryngoscope. 1991; 101: 775-779
        • Fergusson K
        • Ono T
        • Lowe A
        • et al.
        A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.
        Chest. 1996; 109: 1269-1275
        • Schmidt-Nowara W
        • Meade T
        • Hays M
        Treatment of snoring and obstructive sleep apnea with a dental orthosis.
        Chest. 1991; 99: 1378-1385
        • Marklund M
        • Franklin K
        • Sahlin C
        • et al.
        The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea.
        Chest. 1998; 113: 707-713
        • Eveloff S
        • Rosenberg C
        • Carlisle C
        • et al.
        Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea.
        Am J Respir Crit Care Med. 1994; 149: 905-909
        • Wilhelmsson B
        • Tegelberg Å
        • Walker-Engstro¨m M
        • et al.
        A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea.
        Acta Otolaryngol (Stockh). 1999; 119: 503-509
        • Millman R
        • Rosenberg C
        • Carlisle C
        • et al.
        The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty.
        Chest. 1998; 113: 992-996
        • Tegelberg Å
        • Wilhelmsson B
        • Walker-Engstro¨m M
        • et al.
        Effects and adverse events of a dental appliance for treatment of obstructive sleep apnoea.
        Swed Dent J. 1999; 23: 117-126
        • Bondemark L
        • Lindman R
        Craniomandibular status and function in patients with habitual snoring and obstructive sleep apneoa after nocturnal treatment with a mandibular advancement splint: a 2-year follow-up.
        Eur J Orthod. 2000; 22: 53-60
      1. Diagnosis and management of obstructive sleep apnoea syndrome: a State of the Art Conference in Stockholm. Swedish Medical Research Council, Stockholm, Sweden1994
        • Eichner K
        U¨ber eine Gruppeneinteilung des Lu¨ckengebisses fu¨r die Prothetik.
        Dtsch Zahnaerztl Z. 1955; 18: 1831-1834
        • Fujita S
        • Conway W
        • Zorick F
        • et al.
        Surgical correction of anatomic abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty.
        Otolaryngol Head Neck Surg. 1981; 89: 923-934
        • Emsellem HA
        • Corson WA
        • Rappaport BA
        • et al.
        Verification of sleep apnea screening device.
        South Med J. 1990; 83: 748-752
        • Redline S
        • Tosteson T
        • Boucher MA
        • et al.
        Measurement of sleep-related breathing disturbances in epidemiologic studies: assessment of the validity and reproducibility of a portable monitoring device.
        Chest. 1991; 100: 1281-1286
        • Clark G
        • Sohn J
        • Hong C
        Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device.
        J Am Dent Assoc. 2000; 131: 765-771
        • Pantin C
        • Hillman D
        • Tennant M
        Dental side effects of an oral device to treat snoring and obstructive sleep apnea.
        Sleep. 1999; 22: 237-240
        • Grunstien R
        Nasal continuous positive airway pressure treatment for obstructive sleep apnoea.
        Thorax. 1995; 50: 1106-1113
        • Lojander J
        • Brander PE
        • Ammala K
        Nasopharyngeal symptoms and nasal continuous positive air pressure therapy in obstructive sleep apnoea syndrome.
        Acta Otolaryngol. 1999; 119: 497-502

      Linked Article

      • Treatment of Obstructive Sleep Apnea: No Longer Just a Lot of Hot Air
        ChestVol. 121Issue 3
        • Preview
          Obstructive sleep apnea (OSA) has in recent years assumed a somewhat more notorious prominence in the lay press and in the medical literature. With a prevalence of 2 to 4% in the United States,1 where the predisposing factor of obesity is epidemic,2,3 OSA can no longer be regarded as limited to the overweight hypercapneic or morbidly sleepy patient. Moreover, epidemiologic studies have demonstrated an independent relationship between OSA and cardiovascular disease,4,5 OSA and cerebrovascular disease,6,7 and indeed a dose-response relationship with hypertension.
        • Full-Text
        • PDF