Other interventions

Mandibular advancement splints

Mandibular splinting devices are an alternative to continuous positive airway pressure (CPAP) but are only effective in mild to moderate obstructive sleep apnoea. They may also have a role for patients who have ‘simple’ snoring (snoring with minimal apnoea or hypopnoea on sleep study). These splints can be used either to advance the mandible forward or to widen the maxilla.

Mandibular advancement splints must be professionally fitted, and patients need to be regularly reviewed by a dentist. In the long term, they can cause temporomandibular joint pain, changes to the bite and excessive salivation. Simple mouth guards used without dental guidance may damage the teeth and do not work.

Surgery

Maxillary and mandibular reconstructive surgery may be recommended for patients with a significant craniofacial abnormality.

Adenotonsillectomy or nasal decongestive surgery may be helpful if anatomical abnormalities contribute to the patient’s snoring. They alleviate snoring and can improve adherence to other forms of treatment such as CPAP or mandibular advancement splints.

Removal of the soft palate (uvulopalatal pharyngoplasty) and reduction of the tongue base were used in the past, but studies have shown minimal reduction in the apnoea–hypopnoea index. Palatal surgery is now only considered in highly selected cases.

Upper airway pacemaker

Upper airway muscle stimulating pacemakers have been assessed in small short-term studies for sleep apnoea in patients resistant to other forms of treatment. The results have not shown consistent benefit, and long-term adverse effects are not established. At the time of writing, this treatment remains a research tool.