Abstract:Introduction: Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals.Objective: It was the objective of this paper to evaluate a removable mandibular advancement device as it provides a noninvasive, straightforward treatment readily accepted … Show more
“…Similar results were obtained by Giannasi et al, 29,30 who also noted that adjustable MADs gave a greater reduction in daytime sleepiness and in snoring than the rigid appliances. Duarte et al 31 also observed the effectiveness of treating patients with adjustable MADs. In this case the device was inserted at a maximum protrusion of 60%, applying 0.5-to 1-mm increments every 2 weeks.…”
“…Similar results were obtained by Giannasi et al, 29,30 who also noted that adjustable MADs gave a greater reduction in daytime sleepiness and in snoring than the rigid appliances. Duarte et al 31 also observed the effectiveness of treating patients with adjustable MADs. In this case the device was inserted at a maximum protrusion of 60%, applying 0.5-to 1-mm increments every 2 weeks.…”
“…After a full‐text review, 42 studies with 2265 patients of OA were included for Meta‐analysis. The included studies included 6 TRD, 14‐19 and 35 MAD 20‐54 literature. In addition, Barthlen et al 55 incorporated both TRD and MAD.…”
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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