Sleep apnoea in lifters with good body composition

[Dave Lamb]

People with a mild to moderate AHI number and diagnosed with Obstructive Sleep Apnea (OSA) and not Central Sleep Apnea (CSA) could also look into a mandibular repositioning splint. The Narval appliance is a good choice as it won't dislocate your mandibular condyles anteriorly , like other appliances have the potential to do nor will it move the teeth.
The American Academy of Sleep Medicine considers the use of an oral appliance a first line treatment for mild to moderate sleep apnea, AHI 5-30, or in those patients who are intolerant to a cpap. They aren't cheap though, $3000-$4000 range.

Any mandibular repositioning device is going to move your mandibular condyles anteriorly. That's precisely how they work. But, more importantly, your comment suggests that moving your mandibular condyles anteriorly is a bad thing. I have seen no evidence that there are any long-term negative effects from this. There is a temporary influx of fluid in the temporomandibular joint space that causes a sense of bite change in the morning. But this will go away fairly quickly and tends to dissipate with long-term use.

Now, my problem with the Narval and similar appliances is that there are what we call two "points of contact" between the maxilla and mandible. We have two bands on either side of the appliance. One pulls the left side forward and one pulls the right side forward. This can be a problem for your TMJ because unequal amounts of tension between the sides can provoke some serious TMD symptoms.

I think a better appliance is the DreamTAP. It has one point of contact, allows for quite a range of lateral motion, and can be very precisely titrated. There is a reason why the DreamTAP is one of the few dental sleep appliances that is medicare approved.

I agree with the overall sentiment of your post though. As you said, we really shouldn't disregard the effectiveness of dental sleep appliances at treating OSA.

[Jordan Feigenbaum]

Does this change, in any way, your medical advice to people training purely for health reasons?. I'm thinking that informing people of the potential for OSA should be part of an informed consent. You may already do this.
I also wonder what would be the best way for you to get rid of your sleep apnea should you wish to. Other than stopping training which is, of course, not possible.

Eh, I don't think the incidence by which it occurs via training is high enough, though admittedly I have no data on it. On the other hand, I do routinely work up folks for sleep apnea is I suspect it, which is probably due to my bias incurred from having it myself.

[1200cc]

Any mandibular repositioning device is going to move your mandibular condyles anteriorly. That's precisely how they work. But, more importantly, your comment suggests that moving your mandibular condyles anteriorly is a bad thing. I have seen no evidence that there are any long-term negative effects from this. There is a temporary influx of fluid in the temporomandibular joint space that causes a sense of bite change in the morning. But this will go away fairly quickly and tends to dissipate with long-term use.

Now, my problem with the Narval and similar appliances is that there are what we call two "points of contact" between the maxilla and mandible. We have two bands on either side of the appliance. One pulls the left side forward and one pulls the right side forward. This can be a problem for your TMJ because unequal amounts of tension between the sides can provoke some serious TMD symptoms.

I think a better appliance is the DreamTAP. It has one point of contact, allows for quite a range of lateral motion, and can be very precisely titrated. There is a reason why the DreamTAP is one of the few dental sleep appliances that is medicare approved.

I agree with the overall sentiment of your post though. As you said, we really shouldn't disregard the effectiveness of dental sleep appliances at treating OSA.

I misspoke, I should have written that mandibular repositioning can occur with anterior bite plane splints. That's when a splint is worn too extensively and the mandible is moved to a retruded position because the muscles have gotten used to that position. If the pt quits wearing the bite splint the mandible will usually/hopefully go back to maximum intercuspation without a large anterior slide.

The Tap 3 appliance is good, although is not the best for heavy bruxers and often times heavy bruxism and OSA go hand in hand. It can also orthodontically move the teeth. Also, the narval doesn't open the jaw when being worn, like the herbst, silencer, or tap 3 does, and doesn't push the mandible forward, which would seem to be less stressful on the tmj , it protrudes the mandible by retaining it in that position while keeping jaws mostly in the closed position. The narval doesn't cover the incisors which will prevent unwanted orthodontic tooth movement of the anterior teeth. Unwanted tooth movement, never good.