How effective are mandibular advancement devices (MADs) in treating obstructive sleep apnea/hypopnea syndrome (OSAHS), based on polysomnographic measurements, upper airway changes, and symptom improvement?
Background: OSAHS is the most common respiratory disorder to be recognized as a serious public health problem. Although surgical procedures such as maxillomandibular advancement or uvulopalatopharyngoplasty are available, continuous positive airway pressure is the treatment of choice for OSAHS. Oral mandibular advancement devices (MADs) offer a noninvasive alternative.
Study design: Systematic review of 22 studies.
Setting: Medline, Scopus, and Cochrane Library databases.
Synopsis: Of the 22 articles selected, 21 reported on prospective studies and one on a retrospective study. Their quality was high in 16 cases and medium in six. MAD effectiveness in reducing AHI was studied in 18 articles, which showed significant reduction, ranging from 21% to 80%; 16 reported a 50% reduction in AHI or a change in AHI level from severe or moderate to mild. Studies that compared adjustable with fixed or custom-made with prefabricated MADs showed that, in both cases, the former were more effective. Oxygen saturation was assessed in 12 articles, most of which reported improvements. The effectiveness of MADs in decreasing snoring and daytime sleepiness, measured by Epworth Sleepiness Scale, showed significant reductions in almost all 11 studies. Velopharynx size was measured in five studies, all of which showed an increase in upper airway dimensions. The main adverse effects described were muscle and joint disorders, changes in salivation, and occlusal changes.
Limitations included a limited number of medium- or high-quality articles, selection bias, and a variance in definitions of treatment success.
Bottom line: MADs reduce AHI, increase oxygen saturation, and improve the main symptoms of mild to moderate OSAHS. Adjustable and custom-made MADs give better results than fixed and prefabricated appliances, while monobloc appliances cause more adverse effects.
Citation: Serra-Torres S, Bellot-Arcís C, Montiel-Company JM, Marco-Algarra J, Almerich-Silla JM. Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review. Laryngoscope. 2016;126:507-514.