Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 1138510, Japan.
Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-Dori, Cyuo-ku, Nigata-shi, Nigata 9518514, Japan.
Int J Environ Res Public Health. 2019 Aug 31;16(17):3182. doi: 10.3390/ijerph16173182.
Oral appliance (OA) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OA therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OA versus Bi-block OA) remained eligible after applying the exclusion criteria. When comparing Mono-block OA and Bi-block OA, Mono-block OA significantly reduced the apnea-hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; 0.0006), and patient preference for Mono-block OA was significantly higher (2.06; 95%CI, 1.44 to 2.06; < 0.0001). Lowest SpO, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO: -11.18; 95%CI, -26.90 to 4.54; = 0.16, arousal index: 4.40; 95%CI, -6.00 to 14.80; = 0.41, non-REM stage 3: -2.00; 95%CI, -6.00 to 14.80; = 0.41, sleep efficiency: -1.42, 95%CI, -4.71 to 1.86; = 0.40, ESS: 0.12; 95%CI, -1.55 to 1.79; = 0.89, Snoring Scale: 0.55; 95%CI, -0.73 to 1.83, = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, = 1.00). In this systematic review, the use of Mono-block OA was more effective than Bi-block OA for OSA patients.
口腔矫治器（OA）治疗已被证明对治疗阻塞性睡眠呼吸暂停（OSA）有效。本系统评价的目的是阐明装置设计（单块或双块）在 OSA 患者 OA 治疗中的疗效。我们使用推荐分级的评估、制定与评价（GRADE）系统进行了荟萃分析。应用排除标准后，有两项研究（单块 OA 与双块 OA）仍然符合纳入标准。与双块 OA 相比，单块 OA 可显著降低呼吸暂停低通气指数（2.92；95%置信区间（95%CI），1.26 至 4.58；0.0006），且患者更倾向于选择单块 OA（2.06；95%CI，1.44 至 2.06；<0.0001）。两组间最低血氧饱和度（SpO）、觉醒指数、非快速眼动睡眠 3 期、睡眠效率、Epworth 嗜睡量表（ESS）、打鼾量表和副作用均无显著差异（最低 SpO：-11.18；95%CI，-26.90 至 4.54；=0.16，觉醒指数：4.40；95%CI，-6.00 至 14.80；=0.41，非快速眼动睡眠 3 期：-2.00；95%CI，-6.00 至 14.80；=0.41，睡眠效率：-1.42，95%CI，-4.71 至 1.86；=0.40，ESS：0.12；95%CI，-1.55 至 1.79；=0.89，打鼾量表：0.55；95%CI，-0.73 至 1.83，=0.55，副作用：1.00，95%CI，0.62 至 1.61，=1.00）。在本系统评价中，对于 OSA 患者，使用单块 OA 比双块 OA 更有效。
