Though the Army Dental Sleep Medicine Initiative has increased the delivery of oral appliances to personnel over the last several years, the obstructive sleep apnea (OSA) therapy is still only offered to a small percentage of the Department of Veterans Affairs/Department of Defense (VA/DoD) population. The VA/DoD wants better access to oral appliances for the military’s active-duty service members and veterans, according to a clinical practice guideline update released this year.
Why the VA/DoD Wants to Improve Oral Appliance Access
“OSA is highly prevalent in military and veteran populations,” the guideline states, potentially imperiling military readiness. Simultaneously, it’s harder to use CPAP devices in tough field conditions that lack electricity, for example, not to mention lugging around the machine and its corresponding supplies.
People with post-traumatic stress disorder tend to struggle more than other populations with CPAP adherence, another hurdle for CPAP use in military populations. But one study found that veterans with both OSA and PTSD were more likely to use and prefer a different treatment—the mandibular advancement device (MAD) type of oral appliance—which worked just as well for their health outcomes.
Steps to Improve Oral Appliance Access
Based on lessons learned in expanding this service within the DoD since 2017, the guideline recommends these steps moving forward:
- Increase education of primary care providers on the evidence regarding the appropriate patient criteria for MAD treatment of OSA
- Ensure MAD therapy is provided by qualified dental sleep medicine professionals
- Utilize US Food and Drug Administration (FDA) approved, digitally engineered, custom-fabricated, and titratable MADs
- Utilize FDA-approved devices that predict MAD treatment response and verify the therapeutic mandibular position
