This study aimed to evaluate how effective and well-tolerated various designs of mandibular advancement devices (MADs), also called mandibular advancement splints are in managing obstructive sleep apnea (OSA).
While all mandibular advancement devices effectively reduce sleep apnea severity, custom-made MADs offer possible advantages in comfort, adherence, and wear time, making them a more favorable option despite similar efficacy across device types.
This study aimed to evaluate how effective and well-tolerated various designs of mandibular advancement devices (MADs), also called mandibular advancement splints are in managing obstructive sleep apnea (OSA). Researchers focused on titratable versus non-titratable devices and custom-made versus ready-made options.
The study involved a thorough search of databases, such as Ovid MEDLINE, Ovid Embase, etc., to include both randomized controlled trials and observational studies that compared different MAD designs. The decrease in the apnea-hypopnea index (AHI) was the main outcome measure. Differences in Epworth Sleepiness Scale (ESS) scores, patient adherence, and the choice of the device comprised the secondary outcomes. The risk of bias was evaluated via suitable tools for both randomized and non-randomized studies. Data were synthesized using meta-analysis, registering weighted mean differences (WMD) with 95% confidence intervals (CI).
A total of 22 studies (15 randomized trials + 7 non-randomized studies) fulfilled the inclusion criteria. Both titratable and non-titratable MADs suggestively reduced AHI, with no meaningful difference between them. Custom-made devices showed a slightly greater reduction in AHI than ready-made devices (WMD: 1.51; 95% CI: −0.08 to 3.11; P = 0.06). They also led to greater adherence and longer use at night (WMD: 1.19; 95% CI: 0.65–1.73; P < 0.0001).
All types of MADs studied were effective in treating OSA, with no strong evidence leaning towards titratable over non-titratable devices, or vice versa. However, custom-made MADs tended to be better tolerated and safe, with fewer side effects and better adherence. More robust, long-term follow-up is required to reinforce these findings.
American Journal of Orthodontics and Dentofacial Orthopedics
Efficacy and adherence of different mandibular advancement devices designs in treatment of obstructive sleep apnea: A systematic review and meta-analysis
Yanlong Chen et al.
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