Introduction

Introducing Airway Sleep Devices (ASDs)

Airway Sleep Devices (ASDs), also known as mandibular advancement splints (MASs), are custom-fitted oral appliances designed to reposition the lower jaw forward during sleep. This advancement increases the upper airway space, reducing the risk of airway collapse associated with obstructive sleep apnea (OSA) and mitigating snoring. ASDs offer a non-invasive alternative to continuous positive airway pressure (CPAP) therapy and are particularly beneficial for patients with mild to moderate OSA or those intolerant to CPAP.¹

Clinical Efficacy of ASDs

Research supports the effectiveness of ASDs in treating OSA and snoring:

  • A meta-analysis indicates that ASDs can reduce the apnea-hypopnea index (AHI) by approximately 66% in patients with mild to moderate OSA.²
  • ASDs have been shown to improve sleep quality, reduce daytime sleepiness, and enhance overall quality of life in OSA patients.³
  • For patients with mild to moderate OSA or those who cannot tolerate CPAP, ASDs are recommended as an effective treatment option.⁴
  • Oral appliance therapy using ASDs has also demonstrated significant cardiovascular benefits, including reductions in blood pressure, sympathetic nervous system activity, and ventricular stress, along with improvements in endothelial function—with outcomes comparable to CPAP when adherence is considered.⁵

Systemic Comorbidities of OSA

OSA is associated with a broad range of systemic health conditions:⁶

  • Cardiovascular: hypertension, stroke, myocardial infarction, atrial fibrillation, pulmonary hypertension, congestive heart failure
  • Metabolic: glucose intolerance, type 2 diabetes, hyperlipidaemia
  • Neuropsychiatric: depression, anxiety, chronic fatigue
  • Sexual health: reduced libido, sexual dysfunction
  • Gastrointestinal: gastroesophageal reflux disease (GERD), often coexisting due to shared risk factors such as obesity

In certain populations – such as pregnant women – OSA can pose additional risks.⁷ Physiological changes during pregnancy (e.g., airway narrowing, increased oxygen demand, and weight gain) may worsen or reveal underlying sleep-disordered breathing. Pregnant individuals with OSA are more likely to present with comorbid conditions including chronic or gestational hypertension, preeclampsia, gestational diabetes, and cardiomyopathy. Evidence suggests a higher risk of adverse maternal outcomes, underscoring the need for greater awareness and screening in high-risk pregnancies.

  1. Bilston L, Gandevia S. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in OSA. J Appl Physiol. 2014;116(3):314–324.
  2. Liao J, et al. Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg. 2024;170(5):1270–1279.
  3. Scherr SC, et al. Definition of an Effective Oral Appliance for the Treatment of OSA and Snoring. J Dent Sleep Med. 2014;1(1):39–50.
  4. Sutherland K, et al. Oral Appliance Treatment for OSA: An Update. J Clin Sleep Med. 2014;10(2):215–227.
  5. Van Haesendonck C, et al. Cardiovascular Benefits of Oral Appliance Therapy in OSA: A Systematic Review. J Dent Sleep Med. 2015;2(1):9–14.
  6. Rundo JV. Obstructive sleep apnea basics. Cleve Clin J Med. 2019;86(9 Suppl 1):2–9.
  7. Dominguez JE, Krystal AD, Habib AS. Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesth Analg. 2018;127(5):1167–1177.
  8. Sutherland K, Phillips C, Cistulli P. Efficacy vs. Effectiveness in the Treatment of OSA: CPAP and Oral Appliances. J Dent Sleep Med. 2015;2(4):175–181.

Indications for ASD Therapy

ASDs are particularly suitable for:⁸

  • Patients diagnosed with mild to moderate OSA
  • Individuals who are non-compliant or intolerant to CPAP therapy
  • Patients seeking a portable, discreet treatment option
  • Individuals with primary snoring without OSA

Advantages of ASDs

  • Non-Invasive: A conservative alternative to surgical or CPAP-based therapies
  • Higher Patient Compliance: Better tolerated than CPAP due to comfort and ease of use
  • Portability: Compact design makes ASDs ideal for travel
  • Customised Fit: Each device is tailored to the patient’s dental anatomy for optimal function and comfort

Considerations and Contraindications

ASDs may not be appropriate for:

  • Patients with severe OSA (AHI >30) who have not previously trialled CPAP
  • Individuals with significant temporomandibular joint (TMJ) disorders
  • Patients with insufficient dentition or compromised periodontal health
  • Those with central sleep apnea, for which ASDs are not effective

Collaborative Approach

At Optima Sleep, we emphasise a multidisciplinary approach to managing sleep-disordered breathing. We collaborate closely with sleep physicians, general practitioners, dentists, and other healthcare professionals to deliver comprehensive, patient-centred care. Our service includes clinical assessment, digital intraoral scans, custom device fabrication, and ongoing follow-up to ensure long-term treatment success.

Blog Articles

Learn More About OSA & Snoring

A brief explanation of OSA and how ASD therapy offers an effective, non-invasive solution for better sleep.