A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea

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Discipline of Dental Public Health.

Abstract

Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.

Eur J Orthod. 2011 Jan 13.

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	Randy Clare Managing Editor of SleepScholar and RespiratoryScholar
	Dr. Steve Carstensen Pankey Institute for Advanced Dental Education, American Academy of Dental Sleep Medicine.
	Ruchir Patel MD Founder & Medical Director at the Insomnia and Sleep Institute of Arizona.
	Dr. John S. Viviano AADSM Diplomate and member of various sleep organizations. Has lectured internationally on the treatment of Sleep-Disordered Breathing and the use of Acoustic Reflection.
	Jeffroy Wyscarver President, DDME Online, Sleep Lab Technology and Services for the Dental Community.
	Claude Albertario RPSGT, speaker, author and mentor in the field of sleep diagnostics with 25 yrs of management experience in one of New York's premier sleep centers.
	Joseph Anderson Co-Founder and Director of Education for Priority Health Education and Priority Scoring.
	Todd Austin Managed sleep labs and has 15 experience in sleep diagnostics and therapeutic systems. .
	Marietta Bibbs Sleep specialist and manager of Sleep and Neurodiagnostics at Morton Plant Mease Healthcare.
	Bradley Eli DMD, MS Director, San Diego Headache and Facial Pain Center / Sleep Treatment and Research Institute
	Edward Grandi Executive Director of the American Sleep Apnea Association.
	Edward Michaelson MD Board Certified in Pulmonary Medicine, Internal Medicine and Sleep Medicine
	Ashley Truitt Founder & Director of Dental Sleep Medicine Worldwide, Co-Founder of TPT Dental.

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