The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study

Silva, Luciana Oliveira e; Guimarães, Thaís; Pontes, Gabriela Arruda Reinaux; Coelho, Glaury; Badke, Luciana; Fabbro, Cibele Dal; Tufik, Sérgio; Bittencourt, Lia Rita Azeredo; Togeiro, Sônia Maria

doi:10.1007/s11325-020-02183-1

Cited by 10 publications

(11 citation statements)

References 46 publications

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“…Seven studies [29][30][31][32]36,37,54 assessed the adherence only in terms of nights per week: all of them reported a mean nights per week adherence greater than 4. All the studies that assessed the adherence in term of hours per night [33][34][35]42,47,48,53 reported a mean adherence greater than 5. Among the 10 studies that evaluated the adherence both in terms of nights per week and hours per night, 26,[39][40][41][43][44][45]50,56,57 six studies reported a mean nights per week and hours per night adherence greater than 6, 26,40,41,[43][44][45] two studies reported a mean nights per week and hours per night adherence less than 6, 50,57 one study reported an adherence greater than 5 nights per week and greater than 4 h per night 56 and one study reported an adherence of 5-7 nights per week and 3-7 h per night.…”

Section: Results Of Individual Studiesmentioning

confidence: 99%

“…Concerning the hours per night adherence, 15 studies were included in the quantitative synthesis. 26,[33][34][35][40][41][42][43][44][45]47,48,50,53,55 Since only one study reported data of MB MAD, 57 it was excluded. Other 16 studies were excluded: 12 because they did not report the data , [27][28][29][30][31][32]36,37,49,51,52,54 three studies reported only a range of values 38,39,46 and one study because it reported only a range of values without the standard deviation or the p-value referred to baseline data.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…12 studies because they did not report the data 27,28,[33][34][35]42,[47][48][49][51][52][53] and 10 studies because they reported only a range of values without the standard deviation or the p-value referred to baseline data. [30][31][32][36][37][38][39]46,54 The meta-regression analysis evaluating the influence of time on dropout rate was performed only for study subgroups investigating Meta-regression analysis showed that the time significantly influenced the dropout rate both for DB MADs (Q = 10.936, p = .001) and for MB MADs (Q = 6.256, p = .012), as shown in Figure 2.…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…At the end 32 RCT were included in the review. Table 1 reports the characteristics and the results of the individual studies and Figure 1 Three studies compared two DB MADs, [26][27][28] four studies compared DB MADs with MB MADs, [29][30][31][32] four studies compared DB MADs with placebo, [33][34][35][36] two studies compared MB MADs with placebo, 37,38 two studies compared DB MADs with NCM MADs, 39,40 eight studies compared DB MADs with cPAP, [41][42][43][44][45][46][47][48] two studies compared a DB MAD with cPAP and placebo, 49,50 one study compared DB MAD with or without exercise support therapy, 51 two studies compared DB MADs with positional therapy, 52,53 one study compared MB MAD with surgery, 54 one study compared an NCM MAD, a semi-customised MAD, a MB MAD and no treatment, 55 one study compared NCM MAD with cPAP 56 and one study compared MB MAD with conservative treatment and cPAP. 57 The follow-up period varied among the studies included from 1 week to 42.7 months.…”

Section: Re Sultsmentioning

confidence: 99%

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Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta‐analysis and meta‐regression

Bortolotti

Corazza

Bartolucci

et al. 2021

J of Oral Rehabilitation

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Background Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking. Objectives The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom‐made (CM) and non‐custom‐made (NCM) MAD therapies. Search Methods An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science. Selection Criteria Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included. Data Collection and Analysis The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study. Results Thirty‐two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta‐analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128–0.213] with a mean follow‐up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033–6.803]) compared to NCM MADs (5.107 [4.324–5.890]. The meta‐regression showed that the dropout rate increases significantly during time (p < .05). Conclusions There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD. Registration The study protocol was registered on PROSPERO (n. CRD42020199866).

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Section: Results Of Individual Studiesmentioning

confidence: 99%

Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Synthesis Of Resultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

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Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta‐analysis and meta‐regression

Bortolotti

Corazza

Bartolucci

et al. 2021

J of Oral Rehabilitation

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“…The primary limitation to this study is the low number of eligible studies included for analysis [5,7,[9][10][11][12][13][14]. However, seven of the eight included articles are randomized controlled trials, providing substantial evidence to the analysis.…”

Section: Discussionmentioning

confidence: 99%

Continuous Positive Airway Pressure vs Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: An Updated Systematic Review and Meta-Analysis

Pattipati¹,

Gudavalli²,

Zin³

et al. 2022

Cureus

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Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder which has various treatment options, however, continuous positive airway pressure (CPAP) remains the gold standard. The aim of this meta-analysis is to compare the current first-line treatment of OSA, i.e., the continuous positive airway pressure (CPAP) with mandibular advancement devices (MADs) in mild to severe OSA.Objective: This meta-analysis is a comparison of the efficacy of continuous positive airway pressure vs mandibular advancement devices in patients with mild to severe obstructive sleep apnea. The primary objective of the meta-analysis is to compare the efficacy of CPAP vs MADs in the treatment of OSA. This meta-analysis includes randomized control and cross-over studies that compare the efficacy of CPAP and MAD and outcomes are reported in terms of apnea-hypopnea index (AHI), lowest oxygen saturation, and Epworth sleepiness scale both pre-and post-treatment.Data sources and study selection: A PubMed and Cochrane database search was conducted in May 2021 and study bibliographies were reviewed. Randomized clinical trials comparing the effect of CPAP and MAD on AHI, lowest oxygen saturation, and ESS in patients with obstructive sleep apnea were selected. Of the 436 studies initially identified, eight were selected for analysis after screening. The quantitative measures used for comparing the efficacy of CPAP and MAD were post-treatment apnea-hypopnea index (AHI), lowest oxygen saturation, and post-treatment Epworth score scale (ESS).Data extraction and synthesis: A network of meta-analyses was performed using RevMan (Copenhagen, Denmark: Nordic Cochrane Center) where multivariate random-effects models were used to generate pooled estimates. Data were analyzed using generic inverse variance method and P < 0.05 is regarded as statistically significant. Combined summary statistics of standardized (STD) paired difference in mean for individual studies and combined studies was calculated. A chi-square-based test of homogeneity was performed and the inconsistency index (I 2 ) statistic was determined.Results: Compared the AHI, lowest oxygen saturation, and ESS from baseline to follow-up pre-and posttreatment in both CPAP and MAD groups; after the database search 436 records were identified, eight studies were included in the RCT, and three were RCT crossover studies. The duration of treatment varies in each group. AHI, ESS, and lowest oxygen saturation are calculated pre-and post-treatment. Compared with MAD, CPAP was associated with decrease in AHI with a mean difference of -5.83 (95% CI, -8.85, -2.81, P < 0.01). The lowest oxygen saturation was also decreased in CPAP group compared to MAD group with a mean difference of 0.72 (95% CI, 0.51, 0.94, P < 0.01). However, there was no statistically significant difference in ESS between CPAP and MAD group with a mean difference of 0.23 (95% CI, -0.24, 0.70, P = 0.34). The metaanalysis states that among patients with obstructive sleep apnea, both CPAP and MADs are effecti...

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Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta‐analysis

Liao,

Shi,

Gao

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveOral appliances (OA) are the recommended first‐line option for mild‐to‐moderate obstructive sleep apnea (OSA)‐hypopnea. However, there is a lack of evidence to compare the effectiveness of OA in different severities of OSA. The purpose of this study was to investigate the therapeutic effects of preferred OA (tongue retention devices [TRD] and mandibular advancement device [MAD]) in different severities of OSA.Data SourcesPubMed/MEDLINE, The Cochrane Library, and Web of Science.Review MethodsConcentrating on the efficacy of OA, 2 authors searched 3 databases up to November 10, 2022, independently and systematically, following the requirements and steps of the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines.ResultsUltimately, 42 studies with 2265 patients met the criteria for inclusion in OA. Overall, the apnea‐hypopnea index improved by 48% (5.6), 67% (14.92), and 62% (32.1) in mild, moderate, and severe OSA, respectively. Subgroup analysis showed a significant difference between MAD and TRD efficacy in mild OSA (58% vs 21%). However, no significant difference was seen between MAD and TRD efficacy in moderate (67% vs 66%) and severe OSA (66% vs 51%). There was no significant difference across groups in the Epworth Sleepiness Scale, oxygen desaturation index (ODI), and lowest oxygen saturation (LSAT).ConclusionOverall, both TRD and MAD are effective treatments for moderate and severe OSA. MAD is efficacious in mild OSA, while TRD requires further validation. Furthermore, mild‐moderate and severe OSA received similar improvements in sleepiness, ODI, and LSAT. This study complements the evidence for the efficacy of OA.

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The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study

Cited by 10 publications

References 46 publications

Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta‐analysis and meta‐regression

Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta‐analysis and meta‐regression

Continuous Positive Airway Pressure vs Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: An Updated Systematic Review and Meta-Analysis

Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta‐analysis

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