Discipline of Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR.
Am J Orthod Dentofacial Orthop. 2010 Nov;138(5):559-76. doi: 10.1016/j.ajodo.2010.01.030.
The purpose of this study was to review available evidence on the efficacy of various oral appliances on subjectively perceived symptoms of obstructive sleep apnea syndrome.
A search of 4 databases was carried out. Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The finally selected articles were methodologically evaluated.
Of an initial 1475 references, 14 studies were randomized controlled trials, which formed the basis of this review. Mandibular advancement devices (MADs) were compared with either inactive appliances (6 studies) or MADs with different design features (8 studies). In comparison with inactive appliances, the majority of studies showed improved subjective outcomes with MADs, suggesting that mandibular advancement is a crucial design feature of oral appliance therapy for obstructive sleep apnea syndrome.
There is no 1 MAD design that most effectively influences subjectively perceived treatment efficacy, but efficacy depends on many factors including materials and method used for fabrication, type of MAD (monoblock or Twin-block), and the degree of protrusion (sagittal and vertical). This review highlights the absence of universally agreed subjective assessment tools and health-related quality of life outcomes in the literature today. Future trials of MAD designs need to assess subjective efficacy with agreed standardized tools and health-related quality of life measures to guide clinical practicitioners about which design might be most effective in the treatment of obstructive sleep apnea syndrome with oral appliances.
本研究旨在回顾各种口腔器具治疗阻塞性睡眠呼吸暂停综合征主观症状的疗效的现有证据。
对 4 个数据库进行了检索。首先根据标题或摘要选择文章。然后检索全文，并根据预定标准进一步仔细检查。还检索了选定文章的参考文献列表，以查找任何遗漏的出版物。最后对选定的文章进行了方法学评估。
最初的 1475 条参考文献中，有 14 项研究为随机对照试验，为本综述提供了依据。下颌前伸装置（MADs）与非活性装置（6 项研究）或具有不同设计特征的 MADs（8 项研究）进行了比较。与非活性装置相比，大多数研究显示 MAD 可改善主观结局，这表明下颌前伸是口腔器具治疗阻塞性睡眠呼吸暂停综合征的关键设计特征。
没有一种 MAD 设计能最有效地影响主观感知的治疗效果，但疗效取决于许多因素，包括制造用的材料和方法、MAD 的类型（单体或 Twin-block）以及前伸程度（矢状和垂直）。本综述强调了目前文献中缺乏普遍认可的主观评估工具和与健康相关的生活质量结局。未来的 MAD 设计试验需要使用商定的标准化工具和与健康相关的生活质量措施来评估主观疗效，以指导临床医生了解哪种设计在使用口腔器具治疗阻塞性睡眠呼吸暂停综合征方面最有效。
