Small device helps sleep apnea sufferers in a big way

Paul McLornan, B.D.S., assistant professor in the Department of Prosthodontics, is the lead investigator of an 18-month study involving sleep apnea patients at the South Texas Veterans Health Care System, Audie Murphy Division. Researchers used an oral appliance called the Thornton Adjustable Positioner (TAP) to treat those suffering from moderate to severe sleep apnea.

“What we found was that many of our patients with moderate to severe sleep apnea were not adhering to standard treatment with a Continuous Positive Airway Pressure (CPAP) machine,” Dr. McLornan said. Although the CPAP is considered to be the gold standard in treating sleep apnea and is very effective, Dr. McLornan said compliance by patients is well below 50 percent.

“Some patients say the machine (which consists of a face mask connected to tubes) that blows air down a patient’s throat during sleep to keep the airway open is cumbersome or noisy,” Dr. McLornan said. “Some said it was uncomfortable or that it bothered their spouses, or that they were just too embarrassed to use the machine.”

Dr. McLornan’s study proved that the TAP device, which is much smaller and fits in a patient’s mouth, is now an option for patients with severe sleep apnea.

“It was previously thought that treatment for patients suffering from severe sleep apnea was limited to use of the CPAP or surgery,” Dr. McLornan said. “Our study added to the body of medical and dental research literature by showing that oral appliances can be effective in treating people with severe sleep apnea. As an added advantage, the device is less cumbersome, is better tolerated by patients, and is much less invasive and costly than the CPAP or surgery.”

Sandra Langelier, a patient of Dr. McLornan, prepares to wear The Thornton Adjustable Positioner (TAP), an alternative therapy to the CPAP machine for patients with sleep apnea.

Patients in the study were fitted with the TAP appliance and given a tiny key that fits in the front of the device. The patient was instructed to wear the appliance every night and to insert and turn the key several millimeters before bedtime. By turning the key, the patient pulls his lower jaw forward, thus creating an open airway in the throat.

“We asked the patients to tell us when they reached a point in the adjustments that felt comfortable and when they felt they were able to sleep without snoring or gasping,” he said. “We then evaluated patients using standard sleep studies to determine whether or not their sleep had indeed improved.”

Dr. McLornan explained that patients in his study improved significantly using the TAP. “We saw patients who began the study with severe sleep apnea end the study with very mild or no sleep apnea. They reported sleeping better, feeling more rested in the morning and altogether healthier.”

Sandra Langelier said she could barely keep her eyes open during the day. “I was exhausted all the time,” she said. “I had absolutely no energy.” One morning, as Langelier drove her usual 70-mile route to work, her car swerved off the road. She’d fallen asleep at the wheel. “Luckily, I wasn’t hurt and neither was anyone else,” she said. Langelier said she suffered from fatigue and drowsiness nearly every day since she was in high school. “I knew something was wrong, but never knew what it was.”

After undergoing a standard sleep study in 2004, Langelier was diagnosed with moderate sleep apnea. She tried the CPAP machine, and although it worked, she said she found the TAP appliance a better alternative because of its smaller size, transportability and ease to operate and wear at night.

“I’m thrilled the TAP is an option. I’m sleeping better, I have more energy and I just feel better than I ever have,” she said. “Sleep apnea is a real problem and now there are more solutions for everyone. It’s better to catch it early before it gets out of hand.”

Dr. McLornan said this research is vital to both the medical and dental communities.

“Sleep apnea is a growing and serious problem for people of all ages and all ethnic groups,” Dr. McLornan said. “If left untreated, it becomes progressively worse. People suffering from sleep apnea are at increased risk for high blood pressure, heart attacks, strokes, obesity and diabetes. It takes both dentists and medical professionals working together to control this potentially deadly disorder. The TAP gives patients another viable treatment alternative.”

Dr. McLornan said patients who think they may suffer from sleep apnea should consult their family physician and undergo a standard sleep study in a lab. Costs are normally covered by medical insurance.

The American Academy of Sleep Medicine, the professional society that sets the standards for and promotes excellence in sleep medicine, now recommends that oral appliances can be the first line of treatment for people with mild to moderate sleep apnea. Dr. McLornan’s study demonstrates it can be used for patients with severe problems as well.