Abstract
Obstructive Sleep Apnea (OSA) is often treated with Mandibular Advancement Devices (MADs). It is unclear whether particular design features are superior to others in terms of OSA alleviation. In order to facilitate clinical decision-making, this systematic review summarizes the objective and subjective outcomes of different available MAD designs. Studies comparing different MAD designs in OSA treatment were searched. After screening 1887 titles and abstracts, 20 original RCTs and six cohort studies were included. 14 articles were systematically reviewed in a meta-analysis. The decrease in AHI was significantly different between some of the MAD designs. The clinical relevance of the observed differences was however limited. Monoblock appliances performed more favorable, compared to bilateral thrust (effect size:-0.37; CI:-1.81 to 0.07). Midline traction appliances performed more favorable, compared to other designs. Custom appliances performed more favorable, compared to thermoplastic appliances (effect size:0.86; CI:-0.62 to 2.35). Furthermore, there were no clinically relevant differences between MAD designs in reduction of ESS, compliance, preference, side effects, and cost effectiveness. With respect to the included trials, presently there is not one superior custom MAD design in OSA treatment regarding the effect on AHI reduction, ESS improvement, compliance, preference, side effects, cost effectiveness, and other disease-related outcomes. We confirm custom MAD designs perform superior to thermoplastic MAD designs.
| Original language | English |
|---|---|
| Article number | 101557 |
| Pages (from-to) | 1-12 |
| Number of pages | 12 |
| Journal | Sleep Medicine Reviews |
| Volume | 60 |
| Early online date | 1 Oct 2021 |
| DOIs | |
| Publication status | Published - Dec 2021 |
Bibliographical note
Funding Information:NV is a member of the Medical Advisory Board of NightBalance, consultant of Philips Healthcare and Olympus and researcher for Inspire Medical Systems. JL receives research grants from KLS Martin and DePuy Synthes and receives speakers' bureau payments from Academic Centre for Dentistry Amsterdam. GA receives research grant from Sunstar Suisse SA and Vivisol-ResMed and is an unpaid member of the academic advisory board for Oral Function (Sunstar Suisse SA). FL receives research grants from Sunstar Suisse SA, SomnoMed, and Vivisol-ResMed and is an unpaid member of the academic advisory boards for GrindCare and for Oral Function (Sunstar Suisse SA). AH is a medical advisor for Airway Management Inc, SomnoMed, and Zephyr Sleep Technologies.
Funding Information:
NV is a member of the Medical Advisory Board of NightBalance, consultant of Philips Healthcare and Olympus and researcher for Inspire Medical Systems. JL receives research grants from KLS Martin and DePuy Synthes and receives speakers' bureau payments from Academic Centre for Dentistry Amsterdam . GA receives research grant from Sunstar Suisse SA and Vivisol-ResMed and is an unpaid member of the academic advisory board for Oral Function (Sunstar Suisse SA). FL receives research grants from Sunstar Suisse SA , SomnoMed , and Vivisol-ResMed and is an unpaid member of the academic advisory boards for GrindCare and for Oral Function (Sunstar Suisse SA). AH is a medical advisor for Airway Management Inc, SomnoMed, and Zephyr Sleep Technologies.
Publisher Copyright:
© 2021 The Authors
Keywords
- Bilateral thrust
- Mandibular advancement device (MAD)
- Meta-analysis
- Midline traction
- Monoblock
- Obstructive sleep apnea (OSA)
