An Individually Adjustable Oral Appliance vs Continuous Positive Airway Pressure in Mild-to-Moderate Obstructive Sleep Apnea Syndrome

Randerath, Winfried; Heise, M.; Hinz, R.; Ruehle, Karl-Heinz

doi:10.1378/chest.122.2.569

Cited by 213 publications

(181 citation statements)

References 32 publications

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“…19,20 Finally, 14 studies were included in this metaanalysis. [10][11][12][13][14][15][21][22][23][24][25][26][27][28] Among these studies, 8 trials had a crossover design, [10][11][12]15,[21][22][23]27 and 6 had a parallel-group design. 13,14,[24][25][26]28 The main characteristics of the included studies are shown in Table 2.…”

Section: Withdrawals and Dropoutsmentioning

confidence: 99%

“…There were 4 crossover trials [10][11][12]21 and 4 parallel-group trials 13,14,25,26 reporting minimum S pO 2 . Pooled estimates of crossover trials showed that OA-treated subjects had a significantly lower minimum S pO 2 (mean difference Ϫ5.11%, 95% CI -6.91 to -3.30, P Ͻ .001), but there was substantial heterogeneity across the trials (P ϭ .003, I 2 ϭ 78%) (see Fig.…”

Section: Polysomnography Outcomesmentioning

confidence: 99%

“…9 Several studies have demonstrated that OAs can effectively reduce the severity of sleep-disordered breathing and lead to symptomatic improvement, and patients seem to be more adherent to OAs than to CPAP. 10,11 Many randomized trials have compared the outcomes of OAs versus CPAP in the treatment of patients with OSA, [10][11][12][13][14][15] most of which indicate that OAs are less effective in reducing AHI but are preferred over CPAP. However, none of these trials has been large enough to confirm the outcomes within subgroups.…”

Section: Introductionmentioning

confidence: 99%

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The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Xiao

2013

Respir Care

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BACKGROUND: A systematic review and meta-analysis was performed to compare the outcomes of oral appliances (OAs) with those of CPAP in treatment of patients with obstructive sleep apnea (OSA). METHODS: Relevant studies were retrieved from the following electronic databases, up to and including September 2012: MEDLINE, PubMed, EMBASE, and Central Register of Controlled Trials. The main outcomes were Epworth Sleepiness Scale score, health-related quality of life, cognitive performance, blood pressure, apnea-hypopnea index (AHI), arousal index, minimum S pO 2 , percent rapid eye movement sleep, treatment usage, side effects, treatment preference, and withdrawals. RESULTS: Fourteen trials were finally included in this review. Our results demonstrated that the effects on Epworth Sleepiness Scale score (P ‫؍‬ .31 and .09 in crossover and parallel-group trials), health-related quality of life, cognitive performance, and blood pressure of OAs and CPAP were similar. Besides, pooled estimates of crossover trials suggested a significant difference in favor of CPAP regarding AHI (P < .001), arousal index (P ‫؍‬ .001), and minimum S pO 2 (P < .001), while pooled estimates of parallel-group trials showed a significant difference in favor of CPAP regarding AHI (P < .001) and percent rapid eye movement sleep (P ‫؍‬ .02). Moreover, OAs and CPAP yielded fairly similar results in terms of treatment usage (P ‫؍‬ .26 for hours/night in crossover trials, and P ‫؍‬ .14 for hours/night and P ‫؍‬ .19 for nights/week in parallel-group trials), treatment preference, side effects, and withdrawals (P ‫؍‬ .34 in parallel-group trials). CONCLUSIONS: CPAP yielded better polysomnography outcomes, especially in reducing AHI, than OAs, indicating that OAs were less effective than CPAP in improving sleep-disordered breathing. However, similar results from OAs and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer OAs to patients who are unable or unwilling to persist with CPAP.

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Section: Withdrawals and Dropoutsmentioning

confidence: 99%

Section: Polysomnography Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Xiao

2013

Respir Care

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“…Regarding the efficacy of intra-oral devices, several authors state in their studies [16][17][18][19] that they represent a good alternative for treating snoring and OSAH, due to a reduced cost and their relatively comfortable use, being more accepted by patients. Although there are conflicting doubts on the efficacy of intra-oral devices for treating snoring and OSAH, its use in the treatment of medium severity apnea has received great attention and acceptability.…”

Section: Discussionmentioning

confidence: 99%

Tratamento da síndrome da apnéia e hipopnéia obstrutiva do sono com aparelhos intrabucais

Almeida¹,

Teixeira

Vieira

et al. 2006

Rev. Bras. Otorrinolaringol.

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Obst ructive sleep apnea and hipoapnea syndrome (OSAHS) is a disorder that affects about 4% of the adult population, and besides the social problems associated to snoring and extreme day time sleepiness, it is preoccupying since it may cause pulmonary hypertension and cardiac failure. Review and discussion -Through a literature review, we discuss the use of oral appliances to treat this condition, in regards of therapy effectiveness and limitations, main clinical symptoms, major occlusal side effects, rate of improvement and patient satisfaction. Conclusions -We concluded that the use of oral appliances should be a first choice treatment for mild to moderate OSAHS, being dental, joint and muscular discomforts, hypersalivation and xerostomia, the most frequent clinical symptoms, with light occlusal side effects that normally do not bother the patients, with a good degree of improvement and high satisfaction index.

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“…The reduction of the AHI by MADs has been variable but overall 52% of OSA patients experience a reduction in the AHI to less than10/h [59]. According to several studies MADs can decrease daytime hypersomnia [60][61][62][63][64] to a degree comparable to CPAP therapy [62,[65][66][67][68][69]. However, CPAP may produce a better clinical outcome than MADs, as well as better control of snoring [65,[70][71][72].…”

Section: Mandibular Advancement Devices (Mad)mentioning

confidence: 99%

Non-positive airway pressure therapy for obstructive sleep apnea

Jafari

Roux

2012

Curr Respir Care Rep

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Obstructive sleep apnea (OSA) is a common disorder associated with cardiovascular morbidity. Various methods are offered to improve symptoms of OSA and its outcome. Although positive airway pressure is the most effective treatment for OSA, its clinical effectiveness is limited by patients' compliance. Other suggested treatments for OSA focus on expanding upper airway and reducing its collapsibility. For example, mandibular advancement device (MAD) achieves this goal by mechanically protruding the mandible. Other available treatments including weight reduction, positional therapy, drugs, nasal dilators, and nasal expiratory pressure device are clearly inferior to CPAP.

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An Individually Adjustable Oral Appliance vs Continuous Positive Airway Pressure in Mild-to-Moderate Obstructive Sleep Apnea Syndrome

Cited by 213 publications

References 32 publications

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

Tratamento da síndrome da apnéia e hipopnéia obstrutiva do sono com aparelhos intrabucais

Non-positive airway pressure therapy for obstructive sleep apnea

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