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

Li, Wenyang; Xiao, Lizu; Hu, Jing

doi:10.4187/respcare.02245

Cited by 73 publications

(60 citation statements)

References 34 publications

(125 reference statements)

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“…Seven of the reviews on The total mean score for the adult OSA studies was 7.85 ± 1.72 and the scores ranged from 5 to 11. Lie et al 56 had the highest quality among all the reviews (11/11) and Iftikhar et al's 58 review had the lowest (5/11). Of the reviews on pediatric OSA, three were of high quality 15,61,62 and one was medium quality 12 and the total mean score for the studies was 9 ± 1.41 and the range was 7 to 10.…”

Section: R Esu Lt Smentioning

confidence: 99%

“…For the comorbidity outcomes, the quality of the included studies was assessed based on the general impressions of the investigators and not on valid criteria. Although the authors of all the reviews documented conflicts of interest, in only one review 56 did the authors declare conflicts of interest for the individual studies included within the review.…”

Section: Adult Sdbmentioning

confidence: 99%

“…The six reviews 50,52,55,56,59,60 that were identified as having high quality (low risk of bias) found superior efficacy of OAs over controls/placebo/no treatment. These reviews supported a reduction in apnea-hypopnea index (AHI), minimum oxygen saturation level, blood pressure, and arousal index with OAs, in addition to improvement in health-related quality of life.…”

Section: Adult Sdbmentioning

confidence: 99%

“…Only five reviews (38.5%) either assessed publication bias using funnel plots 55,[58][59][60] or described reasons for not investigating it. 56 Five of the 11 MAs 51,56,58-60 conducted sensitivity analyses to assess the robustness of the results.…”

Section: Adult Sdbmentioning

confidence: 99%

“…Therefore, only 17 articles met the inclusion criteria set for this study (Figure 1). Thirteen reviews were on adult OSA (2 SRs and 11 SRs with MAs), 1,[49][50][51][52][53][54][55][56][57][58][59][60] and four reviews were on pediatric OSA (3 SRs and 1 SR with MA). 12,15,61,62 Key methodological and descriptive characteristics of the included reviews are presented in Tables 2 and 3.…”

Section: R Esu Lt Smentioning

confidence: 99%

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Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Al-Jewair

Gaffar

Flores-Mir

2016

Journal of Clinical Sleep Medicine

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Study Objectives: To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). Methods: SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. Results: Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. Conclusions: Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB. Keywords: mandibular advancement device, sleep apnea syndrome, systematic review, treatment efficacy Citation: Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality assessment of systematic reviews on the efficacy of oral appliance therapy for adult and pediatric sleep-disordered breathing. J Clin Sleep Med 2016;12(8):1175-1183. I NTRO DUCTI O NLoud snoring and obstructive sleep apnea (OSA) are common sleep-disordered breathing (SDB) conditions that can affect growing and nongrowing individuals. OSA is characterized by repetitive partial (hypopnea) or complete (apnea) upper airway obstructions lasting at least 10 sec and by snoring during sleep.1 The prevalence in adults ranges from 9% to 24% for OSA and from 2% to 4% for OSA when daytime symptoms are considered.2 SDB/OSA occurs in 1.2% to 5.8% of children and adolescents. 3,4 Multiple factors had been identified in the etiology of SDB/ OSA. These included structural constrictions of the soft tissue space surrounding the oropharynx and nasopharynx and its lumen (i.e., hypertrophied tonsils and/or adenoids), 1 constrictions surrounding the nasal cavity, 5 neuromuscular abnormalities of the upper airway, 1 hyperdivergent craniofacial growth patterns, 6 genetic markers (i.e., tumor necrosis factor-alpha), 7 early life programming 8 (i.e., exposure to secondhand cigarette smoking and poor nutrition), and prenatal factors such as hormonal and physiological changes during gestation, 9 i...

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Section: R Esu Lt Smentioning

confidence: 99%

Section: Adult Sdbmentioning

confidence: 99%

Section: Adult Sdbmentioning

confidence: 99%

Section: Adult Sdbmentioning

confidence: 99%

Section: R Esu Lt Smentioning

confidence: 99%

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Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Al-Jewair

Gaffar

Flores-Mir

2016

Journal of Clinical Sleep Medicine

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Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients

et al. 2021

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Objectives/Hypothesis: Oral appliances (OAs) are a treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). The main objective of the study was to determine the predictive factors of OA efficacy. The secondary objective was to measure the efficacy rates and determine OAs' tolerance and dropout.Study Design: Retrospective study. Methods: Efficacy results of the OAs based on the apnea hypopnea index (AHI) reduction, complications, and dropout rates were retrospectively collected from 347 patients with a moderate to severe OSAHS treated by a retention OA. The procedure was entirely performed by otolaryngologists.Results: The AHI with OA was more significantly reduced in patients with a higher initial AHI and a higher initial body mass index but reduction was not related to age and not proportional to the degree of mandibular advancement. The 50% AHI reduction rate after OA was 65.2%, the AHI ≤5/hr rate after OA was 26.1%, and the <50% AHI reduction and residual AHI > 10/hr rate was 50.1%. The OA significantly reduced the mean AHI (−14.9/hr, P < .0001). In 7.8% of patients, the AHI increased with OA. Seven patients (1.5%) experienced adverse effects. Thirty-seven (7.8%) patients stopped using OA mainly because of its ineffectiveness. Advancement can be considered beyond the initial maximal advancement. It can be effective sometimes; however, increasing advancement did not significantly reduce AHI.Conclusions: OA is an effective and well-tolerated treatment for moderate to severe OSAHS. This treatment was effective for reduction of the AHI ≥50% in two-thirds of cases studied and it should be considered in more cases.

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Therapy of Sleep Disorders in Parkinson’s Disease

Gandor

Ebersbach²

2022

NeuroPsychopharmacotherapy

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

Cited by 73 publications

References 34 publications

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing

Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients

Therapy of Sleep Disorders in Parkinson’s Disease

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