Comparative efficacy of mandibular advancement devices in obstructive sleep apnea: a network meta-analysis

被引：6

作者：

Iftikhar, Imran H. ^{[1
,2
]}

Cistulli, Peter A. ^{[3
,4
,5
]}

Jahrami, Haitham ^{[6
,7
]}

Alamoud, Khalid A. ^{[8
,9
]}

Saeed, Maarij ^{[10
]}

Soulimiotis, Andrew P. ^{[11
]}

BaHammam, Ahmed S. ^{[12
,13
]}

机构：

[1] Emory Univ, Sch Med, Dept Med, Div Pulm Crit Care & Sleep Med, Atlanta, GA 30322 USA

[2] Atlanta Vet Affairs Med Ctr, Atlanta, GA 30033 USA

[3] Univ Sydney, Charles Perkins Ctr, Sleep Res Grp, Sydney, NSW, Australia

[4] Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia

[5] Royal North Shore Hosp, Dept Resp & Sleep Med, Sydney, NSW, Australia

[6] Minist Hlth, Manama, Bahrain

[7] Arabian Gulf Univ, Coll Med & Med Sci, Manama, Bahrain

[8] King Saud bin Abdulaziz Univ Hlth Sci, Coll Dent, Dept Prevent Dent Sci, Riyadh, Saudi Arabia

[9] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia

[10] HITEC Inst Med Sci, Dent Coll, Rawalpindi, Pakistan

[11] North Druid Hills Georgia, Sleep Apnea & Snoring Solut Private Practice, Atlanta, GA USA

[12] King Saud Univ, Univ Sleep Disorders Ctr, Coll Med, Dept Med, Riyadh, Saudi Arabia

[13] Strateg Technol Program Natl Plan Sci & Technol &, Riyadh, Saudi Arabia

来源：

SLEEP AND BREATHING | 2023年 / 27卷 / 04期

关键词：

Mandibular advancement devices; Sleep apnea; Network meta-analysis; ORAL APPLIANCE THERAPY; POSITIVE AIRWAY PRESSURE; RANDOMIZED CROSS-OVER; CONTROLLED-TRIAL; BLOOD-PRESSURE; CPAP; MANAGEMENT; MADS;

D O I：

10.1007/s11325-022-02744-6

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Purpose To analyze relative efficacies of mandibular advancement devices (MAD) in sleep apnea treatment. Methods From eligible randomized controlled trials (RCT), MADs were classified based on their mechanistic designs. Data on apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), nadir oxygen saturation (minSaO(2)), and sleep efficiency (SE%) from RCTs were then analyzed in network meta-analyses, and relative ranking of different MADs was computed based on P scores (a method of ranking similar to SUCRA). Similar analyses were conducted based on the different brands of MADs. Results There were no statistically significant differences between MADs in any of the outcomes analyzed. However, the P-scores, based on the point estimates and standard errors of the network estimates, ranked some MADs higher than others in some of the outcomes. Of the different mechanistic designs, the highest P scores were achieved for attached midline traction (P score = 0.84) and unattached bilateral interlocking (P score = 0.78) devices for AHI reduction, attached bilateral traction (P score = 0.78) and unattached bilateral interlocking (P score = 0.76) for ESS, monobloc (P score = 0.91) and unattached bilateral interlocking (P score = 0.64) for minSaO(2), and unattached bilateral interlocking (P score = 0.82) and attached bilateral traction (P score = 0.77) for SE%. Notable findings in the network meta-analyses based on MAD brands, of the limited number of studies that specified them were the effects of SomnoDent Flex (TM), TAP (TM), and IST (R) in their effects on AHI reduction, with P scores of 0.94, 0.83, and 0.82, respectively. Monobloc decreased supine-AHI the most (- 44.46 [- 62.55; - 26.36], P score = 0.99), and unattached bilateral interlocking had the greatest effect on REM-AHI (- 11.10 [- 17.10; - 5.10], P score = 0.87). Conclusions Findings from this study show clinically (but not statistically) significant differences between MADs in terms of their relative efficacy when analyzed for different sleep apnea treatment outcomes and sleep apnea phenotypes.

引用

页码：1365 / 1381

页数：17