Use of mandibular advancement devices for the treatment of primary snoring with or without obstructive sleep apnea (OSA): A systematic review

Meyer, Micheline M D De; Vanderveken, Olivier M.; Weerdt, Sonia De; Marks, Luc; Cárcamo, Bernadita A; Chavez, Andrés M; Matamoros, Felipe A; Jacquet, Wolfgang

doi:10.1016/j.smrv.2020.101407

Cited by 18 publications

(15 citation statements)

References 67 publications

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“…For this reason, multiple alternative treatment options are being advocated. Treatment options for OSA may include weight loss, mandibular advancement devices (MAD), positional therapy, and upper airways (UA) surgery, including hypoglossal nerve stimulation [ 6 , 7 , 8 , 9 ]. Furthermore, orofacial myofunctional therapy and drug therapy represent an emerging treatment option for OSA [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients’ in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.

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Section: Introductionmentioning

confidence: 99%

OSA Upper Airways Surgery: A Targeted Approach

et al. 2021

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“…Future studies should explore other potential mediators, such as cortisol imbalance or changes in brain structure. In addition, for patients who do not want to receive CPAP therapy, other novel treatments can be used to improve their outcomes [ 32 – 34 ].…”

Section: Discussionmentioning

confidence: 99%

Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study

Zhang

Yang

et al. 2022

Sleep Breath

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Objective To determine the impact of a solitary lifestyle on health-related quality of life (HRQoL) in adults with obstructive sleep apnea (OSA). Methods This was a prospective cohort study; patients diagnosed with OSA but not receiving continuous positive airway pressure (CPAP) therapy were enrolled in our study. These participants completed basic information and the Short Form-36 Health Survey (SF-36) at baseline and were divided into the living alone and living with others groups. Telephone follow-up was performed 1 year later to re-evaluate the SF-36. Differences in health status between and within groups were assessed. In addition, variables associated with changes in the health of the whole population were examined. Results A total of 402 patients with OSA were enrolled, including 120 in the living alone group and the rest in the living with others group. After a year, mental health scores of the living alone group decreased (55.7 ± 21.5 versus 54.1 ± 22.7, p = 0.001), while physical functioning scores of the living with others group increased significantly (82.1 ± 24.7 versus 82.6 ± 24.2, p = 0.006). In the whole population, the determinants of mental health change after 1 year from baseline were alcohol drinking (beta coefficient − 1.169, 95% CI − 2.03 to − 0.309, p = 0.008) and solitary living (beta coefficient − 1.135, 95% CI − 2.072 to − 0.199, p = 0.018). Conclusion Regarding all initial variables, alcohol drinking and solitary living seem to be the predictors of mental health change of patients with OSA in China. We speculate that to improve the quality of life of such people, the medical staff could provide certain social support for them.

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“…A recent comprehensive systematic review of MAD treatment in primary snoring supports its use as a first line treatment option 52 . Given the potential for MAD therapy to adversely affect dental occlusion and the temporomandibular joint, long term customized follow‐up is advised. Level of Evidence : B. Recommendation with level of certainty : High . …”

Section: Recommendations For Treatmentmentioning

confidence: 99%

Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring

Sarkis

Jones

et al. 2023

Respirology

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Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non‐surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.

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Use of mandibular advancement devices for the treatment of primary snoring with or without obstructive sleep apnea (OSA): A systematic review

Cited by 18 publications

References 67 publications

OSA Upper Airways Surgery: A Targeted Approach

OSA Upper Airways Surgery: A Targeted Approach

Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study

Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring

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