Chen Yanlong, Zhang Jingjing, Gao Xuemei, Almeida Fernanda R
Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology, Beijing, China.
Am J Orthod Dentofacial Orthop. 2025 Jun;167(6):635-647.e3. doi: 10.1016/j.ajodo.2025.01.006. Epub 2025 Mar 8.
This systematic review and meta-analysis aimed to evaluate the efficacy and adherence of different mandibular advancement devices (MADs) designed to treat obstructive sleep apnea, focusing on titratable vs nontitratable and custom-made vs ready-made devices.
Registered with the International Register of Systematic Review (PROSPERO CRD42024557402), a comprehensive literature search was conducted across Ovid MEDLINE, Ovid Embase, and Web of Science up to June 2024. Randomized controlled trials and nonrandomized studies comparing MAD designs were included. The primary outcome was apnea-hypopnea index (AHI) reduction. Secondary outcomes included improvements in Epworth Sleepiness Scale scores, adherence rates, and patient preference. The risk of bias was assessed using the risk-of-bias tool for randomized trials, and the Risk-Of-Bias In Nonrandomized Studies of Intervention tools. Meta-analyses were performed with weighted mean differences (WMD) and 95% confidence intervals (CI).
A total of 22 studies were included, comprising 15 randomized controlled trials and 7 nonrandomized studies. Meta-analysis showed significant AHI reduction with both titratable and nontitratable MADs, with no significant difference between groups (WMD: 1.16; 95% CI, -1.29 to 3.61; P = 0.35). Custom-made MADs demonstrated a marginally significantly greater reduction in AHI compared with ready-made MADs (WMD: 1.51; 95% CI, -0.08 to 3.11; P = 0.06). Custom-made MADs also showed higher adherence rates and longer wearing times (WMD: 1.19; 95% CI, 0.65-1.73; P <0.0001) and higher adherence rates.
Both titratable and nontitratable MADs, as well as custom-made and ready-made MADs, effectively treated obstructive sleep apnea, with no clear preference for one design over another. Custom-made MADs, however, generally had fewer side effects and offered potential adherence advantages. Further high-quality studies with longer follow-ups are recommended.
本系统评价和荟萃分析旨在评估不同下颌前移装置（MAD）治疗阻塞性睡眠呼吸暂停的疗效和依从性，重点关注可滴定式与不可滴定式以及定制式与成品式装置。
在国际系统评价注册库（PROSPERO CRD42024557402）注册后，截至2024年6月，在Ovid MEDLINE、Ovid Embase和Web of Science上进行了全面的文献检索。纳入比较MAD设计的随机对照试验和非随机研究。主要结局是呼吸暂停低通气指数（AHI）降低。次要结局包括Epworth嗜睡量表评分改善、依从率和患者偏好。使用随机试验的偏倚风险工具和干预性非随机研究中的偏倚风险工具评估偏倚风险。采用加权平均差（WMD）和95%置信区间（CI）进行荟萃分析。
共纳入22项研究，包括15项随机对照试验和7项非随机研究。荟萃分析显示，可滴定式和不可滴定式MAD均能显著降低AHI，两组之间无显著差异（WMD：1.16；95%CI，-1.29至3.61；P = 0.35）。与成品式MAD相比，定制式MAD在降低AHI方面显示出略显著更大的效果（WMD：1.51；95%CI，-0.08至3.11；P = 0.06）。定制式MAD还显示出更高的依从率和更长的佩戴时间（WMD：1.19；95%CI，0.65 - 1.73；P <0.0001）以及更高的依从率。
可滴定式和不可滴定式MAD以及定制式和成品式MAD均能有效治疗阻塞性睡眠呼吸暂停，没有明显偏好一种设计优于另一种。然而，定制式MAD通常副作用较少，并具有潜在的依从性优势。建议进行进一步的高质量长期随访研究。
