Ready-made versus custom-made mandibular advancement appliances in obstructive sleep apnea: A systematic review and meta-analysis.

Mandibular advancement appliances (MAAs) are an increasingly accepted treatment choice in obstructive sleep apnea management. The ready-made MAAs has questioned the need for a customised MAAs, given the former is more accessible and considerably cheaper. We conducted a systematic review and meta-analysis to evaluate both objective and patient-centred outcomes in relation to ready-made and custom-made MAAs s. Biomedical electronic databases, clinical trials registers and Grey literature were searched to January 2017, for randomised controlled trials. Meta-analyses of clinical trials were conducted for a range of objective (apnea-hypopnea index, treatment response) and subjective scales (daytime sleepiness; quality of life; patient preference and adherence). The review included three randomised controlled trials, which revealed low risk of bias. Custom-made MAAs s achieved a significant mean difference in the apnea-hypopnea index (-3.2; 95% confidence interval -5.18, -1.22; p = .004), daytime sleepiness (-0.98; 95% confidence interval -1.97, 0.01; p = .05), observed mean difference in Functional Outcomes of Sleep Questionnaire scores (0.76; 95% confidence interval 0.14, 1.38; p = .02), self-reported adherence (6.4-7 nights per week and 5-6.3 hr per night) and expressed preference (p ≤ .001) when compared with the ready-made MAAs s. Custom-made MAAs s offer clear definable advantages, demonstrating significant clinical effectiveness, patient preference and adherence.