The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

Yuki Sakamoto, Akifumi Furuhashi, Eri Komori, Hiroyuki Ishiyama, Daichi Hasebe, Kazumichi Sato and Hidemichi Yuasa
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Yuki Sakamoto: Department of Oral Surgery, Hironokogen Hospital, 3-1-1 Kitayamadai Nishi-ku Kobe-shi, Hyogo 6512215, Japan
Akifumi Furuhashi: Department of Oral and Maxillofacial Surgery, Aichi Medical University, 1-1 Yazakokarimata Nagakute-shi, Aichi 4801103, Japan
Eri Komori: Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College. 2-7 Daigaku-machi Takatsuki-shi, Osaka 5698686, Japan
Hiroyuki Ishiyama: Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 1138510, Japan
Daichi Hasebe: Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-Dori, Cyuo-ku, Nigata-shi, Nigata 9518514, Japan
Kazumichi Sato: Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano Ichikawa-shi, Chiba 2728513, Japan
Hidemichi Yuasa: Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, 50 Imure-chou Aza Hamamichi-Ue, Toyohashi-shi, Aichi 4408510, Japan

IJERPH, 2019, vol. 16, issue 18, 1-11

Abstract: This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed.

Keywords: oral appliance; mandibular protrusion; obstructive sleep apnea; systematic review (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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