Bortolotti Francesco, Corazza Giulia, Bartolucci Maria Lavinia, Incerti Parenti Serena, Paganelli Corrado, Alessandri-Bonetti Giulio
Section of Orthodontics, Department of Biomedical Sciences, University of Bologna, Bologna, Italy.
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy.
J Oral Rehabil. 2022 May;49(5):553-572. doi: 10.1111/joor.13290. Epub 2021 Dec 10.
Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking.
The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom-made (CM) and non-custom-made (NCM) MAD therapies.
An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science.
Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included.
The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study.
Thirty-two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta-analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128-0.213] with a mean follow-up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033-6.803]) compared to NCM MADs (5.107 [4.324-5.890]. The meta-regression showed that the dropout rate increases significantly during time (p < .05).
There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD.
The study protocol was registered on PROSPERO (n. CRD42020199866).
下颌前移装置（MADs）被用作持续气道正压通气的替代方法来治疗阻塞性睡眠呼吸暂停（OSA）患者，但迄今为止，缺乏关于MAD治疗依从性的具体数据。
本系统评价的目的是调查OSA患者对不同定制（CM）和非定制（NCM）MAD治疗的退出率和依从性。
在MEDLINE、Cochrane系统评价数据库、Scopus、LILACS和科学网进行电子检索。
纳入评估成人OSA患者使用定制和非定制MADs治疗依从性的随机对照试验（RCTs）。
使用推荐分级评估、制定和评价（GRADE）对证据质量进行评估，并使用Cochrane协作网评估RCT偏倚风险的工具评估偏倚风险。计算每项研究的退出率，并从每项研究中提取每晚使用小时数和每周使用天数方面的MAD治疗依从性。
纳入32项RCTs。大多数研究的偏倚风险较低。GRADE评分表明证据质量从极低到中等。荟萃分析显示，CM和NCM MADs之间的平均退出率无显著差异：总体平均退出率为0.171[0.128 - 0.213]，平均随访4.1个月。与NCM MADs（5.107[4.324 - 5.890]）相比，CM MADs每晚使用小时数的依从性显著更高（6.418[6.033 - 6.803]）。荟萃回归显示，退出率随时间显著增加（p < 0.05）。
有极低到中等质量的证据表明，CM和NCM MADs的MAD治疗退出率相似，退出率随时间显著增加，且CM MADs每晚使用小时数的依从性高于NCM。
该研究方案已在PROSPERO注册（编号CRD42020199866）。
