A while back, we blogged about how GLP-1 drugs were starting to be considered for treating obstructive sleep apnea (OSA) – as well as the limitations of going that route.
We’re not the only ones asking these kinds of questions.
A recent paper in Sleep Review picks up on the theme, exploring what the success of these drugs may reveal about the nature of OSA itself.
Citing a recent meta-analysis on the relationship between obesity and obstructive sleep apnea, the paper’s author notes that only about one-third of adults with the condition are obese. Yet so much of the current conversation about treating OSA still centers on weight.
As neuroscientist Elie Gottlieb, PhD, who was not involved in the study, notes, “Where this study adds the most value is in reminding the field that a treatment strategy anchored exclusively to weight loss—whether through GLP-1 receptor agonists, bariatric surgery, or lifestyle intervention—will leave a substantial portion of the OSA population without a clear therapeutic path.”
That would be about two-thirds of people living with apnea that may be driven by other factors – including dental ones.
The size and shape of the airway, jaw position, tongue posture, muscle responsiveness, and how the brain regulates breathing during sleep can all influence whether the airway stays clear during sleep or becomes blocked. When these kinds of structural and functional factors are playing a significant role in OSA, it only makes sense to look at therapies that work directly on the airway itself.
One of the most established options is oral appliance therapy, or “OAT” for short. This involves using a device to either gently reposition the lower jaw or hold the tongue forward during sleep, keeping the airway open. The specific type of device depends upon the patient’s specific needs.
Recent research continues to show how effective OAT can be, especially for people with mild to moderate sleep apnea. A consistent theme runs through that research, as well: The best results tend to come from devices that are customized and adjustable.
As with biological dentistry as a whole, it’s not one-size-fits-all.
For instance, one 2024 study involved patients using what’s called a titratable mandibular advancement device (MAD) – in other words, an adjustable device to hold the lower jaw forward. Compared to a control group using traditional devices, those with the personalized devices had meaningful improvements in their breathing during sleep. They also experienced fewer side effects – likely because the MAD’s position could be fine-tuned, not forcing the jaw into a fixed position.
A study from last year found something similar. Using custom-fitted, adjustable devices, the researchers reported an overall success rate of just over 70%, with particularly strong results in patients with moderate sleep apnea. Again, customization appeared to be key – the ability to tailor the treatment to each individual patient, making adjustments as needed.
In fact, the research team went so far as to conclude that using a MAD “should be considered as an initial treatment option within this subset of patients, inclusive of those with initially severe, moderate, and mild” sleep apnea. That “subset of patients” included people with moderate to severe airway blockage, mainly by the tongue and tonsils.
The same point was reinforced by a 2025 review: These types of devices can reduce the severity of sleep apnea and improve symptoms. On the whole, the scientific evidence showed that
MAD therapy is an effective and generally well-tolerated option for adults with mild-to-moderate OSA and for the patients intolerant to CPAP….
But outcomes vary, the researchers noted, depending on how well the appliance is designed, fitted, and managed over time.
Put all of this together, and a clear picture starts to emerge: Oral appliance therapy works best when it’s personalized.
Sure, a generic, over-the-counter device might seem like a simple and economical fix, especially with how heavily they’re marketed online. But without proper fit, adjustability, and follow-up, they’re unlikely to deliver the same kind of results. In some cases, they may be of little help – or worse, cause problems for your bite.
It’s a point that bears repeating: If sleep apnea can be driven by a range of different factors, then effective treatment starts with identifying which of those factors are in play.
This is the biological approach we take, looking carefully at the airway and contributing factors and how they come together for each individual patient before recommending a course of care.
Once you’ve identified the root cause, identifying its solution becomes a lot easier.