Position Statement: Use of Oral Appliances for the Treatment of Obstructive Sleep Apnea (OSA)

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) is committed to the highest standards of care and ensuring patients receive quality care for obstructive sleep apnea (OSA). The AAO-HNS represents approximately 12,000 physicians in the United States who diagnose and treat disorders of the ears, nose, throat, and related structures of the head and neck. The medical ailments evaluated and treated by our specialty are the most common that afflict all Americans, old and young, including disorders of the oral cavity, airway obstruction, snoring and sleep disorders, swallowing disorders, maxillofacial trauma, temporomandibular joint disorders, hearing loss, balance disorders, chronic ear infections, rhinological disorders, facial and cranial nerve disorders, and head and neck cancer. Medical and surgical therapies related to the oral cavity (including oral health, the temporomandibular joint, dental occlusion and associated oral structures) are specifically part of the required training and expertise of physicians trained in Otolaryngology Head and Neck Surgery. Otolaryngologists are trained and qualified in oral medicine, surgery, and sleep medicine. Dental impressions and bite registrations, needed for fabrication of an oral appliance, are part of the Otolaryngologists training for a variety of maxillofacial conditions, such as repair of mandibular and maxillary fractures, reestablishment of function after oral cancer resection, and reconstruction after surgical transoral, transpalatal, or transmaxillary approaches to the skull base.

Otolaryngologists receive training in sleep medicine, temporomandibular joint disorders, dental occlusal disorders and treatment of oral cavity disorders as part of the core curriculum for the American Board of Otolaryngology. The American Board of Otolaryngology is one of the sponsoring boards for Sleep Medicine sub-certification within the American Board of Medical Specialties. Thus, Otolaryngologists are clearly and uniquely well-qualified to provide a wide array of snoring and sleep apnea therapies related to the oral cavity, including medical, surgical, and device therapies.

OSA is a highly prevalent syndrome resulting from upper airway obstruction associated with deleterious medical conditions such as hypertension, stroke and congestive heart failure as well as health concerns such as increased motor vehicle accidents and impaired quality of life. As such, obstructive sleep apnea is classified as a medical disorder.

The Diagnosis of Obstructive Sleep Apnea

It is the recommendation of the AAO-HNS that patients presenting with symptoms of OSA require a face-to-face evaluation conducted by a qualified physician trained in Otolaryngology-Head and Neck Surgery or Sleep Medicine (one who maintains certification from the American Board of Sleep Medicine or one of the sponsoring sleep medicine boards of the American Board of Medical Specialties, including the American Board of Otolaryngology).

Treatment Therapies for Obstructive Sleep Apnea

Therapies for OSA, including positive airway pressure (PAP), upper airway reconstructive surgery and oral appliance therapy (OAT), must be prescribed by a physician (MD or DO) as described above.

Fitting of an Oral appliance for Obstructive Sleep Apnea

Oral appliances are a treatment of the upper airway. An oral appliance device for the medical treatment of Obstructive Sleep Apnea may be fit, adjusted, and medically assessed by an Otolaryngologist or a qualified Dentist with training in Sleep Medicine. An Otolaryngologist is an MD or DO physician who has satisfactorily completed an accredited training program in Otolaryngology-Head and Neck surgery. A qualified Dentist, as defined by The American Academy of Dental Sleep Medicine (AADSM) is a Dentist who maintains certification from the American Board of Dental Sleep Medicine, or one who is the director of an AADSM-accredited dental facility and has completed 30 hours of continuing education (ADA CERP recognized or AGD PACE approved) within the past three years, of which a minimum of 20 credits must be in dental sleep medicine and the rest must be sleep medicine related.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.