Predictors of Success in the Treatment of Obstructive Sleep Apnea Syndrome with Mandibular Repositioning Appliance: A Systematic Review

Abstract

Introduction Obstructive sleep apnea syndrome affects up to 4% of middle-aged men and 2% of adult women. It is associated with obesity. Objective The objective of this article is to review the literature to determine which factors best correlate with treatment success in patients with obstructive sleep apnea syndrome treated with a mandibular repositioning appliance. Data Synthesis A search was performed of the PubMed, Cochrane, Lilacs, Scielo, and Web of Science databases of articles published from January 1988 to January 2012. Two review authors independently collected data and assessed trial quality. Sixty-nine articles were selected from PubMed and 1 from Cochrane library. Of these, 42 were excluded based on the title and abstract, and 27 were retrieved for complete reading. A total of 13 articles and 1 systematic review were considered eligible for further review and inclusion in this study: 6 studies evaluated anthropomorphic and physiologic factors, 3 articles addressed cephalometric and anatomic factors, and 4 studies evaluated variables related to mandibular repositioning appliance design and activation. All the studies evaluated had low to moderate methodologic quality and were not able to support evidence on prediction of treatment success. Conclusion Based on this systematic review on obstructive sleep apnea syndrome treatment, it remains unclear which predictive factors can be used with confidence to select patients suitable for treatment with a mandibular repositioning appliance.

Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review

“…Nevertheless, the clinical utility of cephalometric measurements in the prediction of MAD treatment outcomes in OSA remains controversial. A recently published review by Saffer et al 11 found no clear predictors of MAD treatment success. However, cephalometric and anatomical factors were not investigated because no randomized controlled trials addressing this issue were included in the review.…”

Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea

“…However, other studies have suggested that younger age, lower BMI, smaller upper airways, less collapsibility in the upper airways, high hyoid bone position, and non-REM dominated and nonpositional OSA may be more important than Friedman score for predicting AHI improvement in MAS treatment [11,19,29]. Nevertheless, there are still uncertainties regarding the significance of predictors in successful MAS treatment [19,36]. erefore, Friedman score cannot be used to decide whether CPAP or MAS treatment is the most suitable for individual patients with nonsevere OSA.…”

Review of systematic reviews on mandibular advancement oral appliance for obstructive sleep apnea: The importance of long-term follow-up

“…Liu et al [3] did not describe the types of OA, and hence those SRs were excluded. Ultimately, 27 articles were included [1,[4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29]]. Descriptions of the included SRs are shown in Table 1.…”

“…Breakdown of the content of the 27 SRs is as follows: there were 10 articles on comparison with other treatments [1,9,12,13,[18], [19], [20],22,24,27], five articles on the types of OAm [5,6,14,16,21], and six articles on the effect of OAm and the associated side effects [4,8,23,26,28,29]. There were also three articles on predicting the therapeutic effect of OAm [10,11,15], two articles on changes in the upper respiratory tract caused by this therapy [7,25], and one article on a remotely controlled mandibular positioner [17]. The SR by Okuno et al [15] based on predicting the therapeutic effects of OAm was the latest.…”