I
ssues and
P
eople
Generating evidence
Tohelpclose theevidencegap, Dr. Almeida is co-leading
amultinational initiative for evaluating the long-term
effectivenessof oral appliance therapy inOSApatients.
Formed in2012, thenetwork calledORANGE (Oral Appliance
NetworkonGlobal Effectiveness) alsoaims toassess the
long-termhealthoutcomesof oral appliance therapy, in
relation tocardiovascular disease.
5
Thenetwork involves
sixteen researchers inmedicineor dentistry fromnine
countries. “Everyonewasdoing their own small studies. So
webrought everyone together and said, ‘Canweas agroup,
standardize thedatawearecollectingand followpatients for
a longperiodof time?’” Collectively, thenetworkhopes to
followat least 1,000patientsover fiveyears. Her goal, like the
ORANGEnetwork itself, dependsoncollaborationbetween
thedental andmedical communities. “My role is togenerate
enoughevidenceon theeffectivenessof oral appliances so
that physicianswill recommend them to their patients.”
Inanother study, Dr. AlmeidaandDr. NellyHuynh, in
collaborationwith researchers fromUBC, theUniversity
ofMontreal andLaval University, areevaluatinghoworal
appliance therapy stacksupagainstCPAP for long-term
treatment effectiveness. Their CIHR-funded studywill usea
randomizedcontrolled trial toassesspatient adherence to
treatment (objectivelymeasured rather than self-reported),
treatment efficacy, patient preference, sleepiness andquality
of life. For doctors anddentists, the study resultswill offer
new insights into thepotential benefits anddrawbacksof
treatment options for their patientswith sleepapnea.
The roleof dentists
Althoughdentistsdon’t diagnose sleepapnea, theyhavean
important role toplay in supporting their patients. “Dentists
can identifypatients at riskof sleepapneaand refer them
to their familyphysicians. Qualifieddentists canalsofit oral
appliances for patientswithaprescription from their family
doctor,” saysDr. Almeida. “Physicianshave tobe involved
because sleepapnea is ahealth-relatedproblem that comes
hand-in-handwithhypertension, atrial fibrillation,with
diabetes. Physicians canalso refer thepatient toa sleep
specialist.”
There’s aneed formore recognitionof theproblems
associatedwithOSAandeasier access to treatment, sheadds.
“It cannot bedonebya few specialists,” saysDr. Almeida.
“Helpingpeopleget the treatment theyneedhas tocome
from theentiredental community.”
a
References
1.GovernmentofCanada.What isthe impactofsleepapneaonCanadians?Ottawa:PublicHealthAgency
ofCanada;2010[accessed2015Jan19].Available:http://www.phac-aspc.gc.ca/cd-mc/sleepapnea-
apneesommeil/ff-rr-2009-eng.php
2.PhillipsCL,GrunsteinRR,DarendelilerMA,MihailidouAS,SrinivasanVK,YeeBJ,etal.Healthoutcomesof
continuouspositiveairwaypressureversusoralappliancetreatment forobstructivesleepapnea:
arandomizedcontrolledtrial.
AmJRespirCritCareMed.
2013;187(8):879-87.
3.AnandamA,PatilM,AkinnusiM,JaoudeP,El-SolhAA.Cardiovascularmortality inobstructivesleep
apnoeatreatedwithcontinuouspositiveairwaypressureororalappliance:anobservationalstudy.
Respirology.
2013;18(8):1184-90.
4.HolleyAB,LettieriCJ,ShahAA.Efficacyofanadjustableoralapplianceandcomparisonwithcontinuous
positiveairwaypressure forthetreatmentofobstructivesleepapneasyndrome.
Chest.
2011;140(6):
1511-6.
5.AlmediaFR,VandervekenOM,CistulliPA,FleuryB,GagnadouxF,etal.ORalApplianceNetworkonGlobal
Effectiveness(ORANGE):Start-upanddesigndescription.
JDentSleepMed.
2014;1(1):17-20.
6.CollegeofDentalSurgeonsofBritishColumbia.Obstructivesleepapnea:theroleofdentists inthe
treatmentofsnoringandobstructivesleepapneawithoralappliances.[accessed2015Jan19].Available:
/
Theviewsexpressedarethoseoftheauthoranddonotnecessarilyreflecttheopinionsorofficialpoliciesofthe
CanadianDentalAssociation.
