The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials

Abstract

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO2 , arousal index, Epworth Sleepiness Scale (ESS), the SF-36 Health Survey. We performed this meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: -7.05 events h(-1) ; 95% CI, -12.07 to -2.03; P = 0.006, arousal index: -6.95 events h(-1) ; 95% CI, -11.75 to -2.15; P = 0.005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO2 and SF-36 than CPAP, (favouring OA, AHI: 6.11 events h(-1) ; 95% CI, 3.24 to 8.98; P = 0.0001, lowest SpO2 : -2.52%; 95% CI, -4.81 to -0.23; P = 0.03, SF-36: -1.80; 95% CI, -3.17 to -042; P = 0.01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO2 and SF-36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.

Obstructive sleep apnea: Aetiology, diagnosis, treatment

“…45 Do podobnych wniosków doszli Okuno i wsp. 46 Smith i Stradling przedstawiają natomiast obie metody jako rów-nie skuteczne w leczeniu OBS. 47 Badanie ankietowe McGowna i wsp.…”

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

“…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.…”

“…57 In that review, 57 randomized trials with both parallel and crossover designs were combined in the MA without justification. 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.…”

“…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.…”

Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy

“…The main function of MAD is to protrude the mandible forward, causing the airway to remain open during sleep [9]. MAD therapy is also an alternative when patients reject CPAP or when CPAP is not tolerated for various reasons [12]; however, the effect is less powerful than that achieved with CPAP [13].…”