Sleep Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain.
Sleep Med Rev. 2022 Aug;64:101644. doi: 10.1016/j.smrv.2022.101644. Epub 2022 May 6.
Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. The aim of this systematic review is to identify predictors of the efficacy of oral appliance (OA) therapy for OSA in adult patients. This review focuses on performing the quantitative analysis by subgroups based on the response criteria used in the literature and based on the type of device. PubMed, EMBASE, Scopus, Web of Science and Cochrane databases was conducted to identify potentially relevant studies published until Dec 2021. The search identified 1343 preliminary references. A total of 99 studies met the eligibility criteria and were included in the review, and 60 in the meta-analysis. The quality of studies was assessed using the Newcastle-Ottawa scale and the Cochrane scale. Based on meta-analysis, and considering a low to moderate evidence profile according to the GRADE scale, responders are younger patients, with smaller neck circumference, lower body mass index. Responders have shorter maxillary length, lower anterior and posterior facial height, a shorter distance from the hyoid bone to the third cervical vertebra, a shorter airway length, a smaller minimum airway cross-sectional area and a higher minimum oxygen saturation during sleep. Responders needed a lower optimal continuous positive airway pressure than non-responders. The type of device has not affected the results of the meta-analysis. The criterion "AHI <10 and reduction AHI >50%" is the one that provides the "weight" of significance for several variables. This criterion should be taken into consideration for future studies to predict OSA treatment by OA.
下颌前移装置（MAD）治疗是阻塞性睡眠呼吸暂停（OSA）最常用的二线治疗方法，但在亚组患者中，MAD 可能无效。本系统评价的目的是确定口腔矫治器（OA）治疗成人 OSA 疗效的预测因素。本综述重点根据文献中使用的反应标准和装置类型，按亚组进行定量分析。在 PubMed、EMBASE、Scopus、Web of Science 和 Cochrane 数据库中进行检索，以确定截至 2021 年 12 月发表的潜在相关研究。该检索共识别出 1343 篇初步参考文献。共有 99 项研究符合纳入标准，并纳入本综述，其中 60 项研究进行了荟萃分析。使用纽卡斯尔-渥太华量表和 Cochrane 量表评估研究质量。基于荟萃分析，并根据 GRADE 量表考虑低到中等证据水平，反应者是年龄较小、颈围较小、体重指数较低的患者。反应者的上颌长度较短、前后面高较低、舌骨与第三颈椎之间的距离较短、气道长度较短、最小气道横截面积较小、睡眠时最低氧饱和度较低。反应者需要的最佳持续气道正压通气比非反应者低。装置类型未影响荟萃分析的结果。“AHI<10 和 AHI 降低>50%”这一标准为几个变量提供了“权重”意义。在未来的研究中，应考虑这一标准来预测 OA 治疗 OSA。
