Comparison Of Adjustable And Fixed Oral Appliances For The Treatment Of Obstructive Sleep Apnoea- A Systematic Review.

Abstract

Introduction: Sleep apnea is defined as frequent episodes of apnea and hypopnea and functional impairment which could be life threatening. Obstructive sleep apnea (OSA) may be mild, moderate or severe. The treatment options available for the treatment of OSA is use of oral appliances in cases of mild to moderate sleep apnea and use of continuous positive airway pressure (CPAP) or surgery in cases of severe sleep apnea. Though CPAP is the gold standard for the treatment of severe sleep apnea, it lacks patient’s compliance. Oral appliances are preferred by these patients as they are more convenient to use. The aim of the study was to compare the efficacy of two implant-retained Mandibular advancement devices in completely edentulous patients with Obstructive sleep apnea.

Materials and methods: A PRISMA-based systematic review was conducted. The checklist (Reporting Items for Systematic Reviews and Meta-Analyses) was used. A thorough computerized database search was carried out. EBSCO and PubMed were used. The keywords used in the search included "Obstructive sleep apnea" in addition to "Oral appliance” PLUS "Dentistry. Only full-text articles published in English are accepted and with a publication date within the previous ten years The years 2008-2023 were included.

Studies comparing fixed and removable oral appliances were taken into consideration. Another filter applied to the database search only returned articles about patients who are human. Following that, the titles and the significance of the abstracts of all papers in terms of the effectiveness and efficacy of oral appliances. If an abstract did not give enough information to decide whether to include or exclude it, the full text of the paper was retrieved for a more thorough evaluation. The initial search in the electronic database PubMed, using the keywords "Obstructive sleep apnea" AND "Oral appliance" AND "Dentistry," yielded 217 papers; the same search in the EBSCO database yielded 45 articles. As a result, the electronic database search yielded a total of 262 documents. Based on the title and abstract review, 190 papers were removed, leaving 72 suitable articles.  The remaining 72 papers were submitted to a complete text examination, with 57 being eliminated. As a result, 15 studies were included in the current systematic review.

Results: The type of oral appliance employed in the research varies greatly. Ten of the studies utilized custom-made MADs, two used the Twin Bloc, two used prefabricated MADs, and one used a modified full denture. The quality of the evidence was moderate for ESS, AHI, and usage compliance due to the risk of bias of the included studies. The quality of the evidence was low for the outcomes SF-36 mental health sub score, physical functioning sub score, EDSI, and FOSQ due to risk of bias and small number of studies with small sample size; low evidence grading indicates that further research is very likely to have an important impact on our confidence in the estimate of effect and it is likely to change the estimate. The meta-analysis of SF-36 physical component summary and emotional quality of life as well as Trail Making B (cognitive function) provided very low quality of evidence due to risk of bias, inconsistency, and imprecision; for those outcomes, we are very uncertain about the estimate.

Conclusion: The mandibular advancement device, as demonstrated in the current systematic review, is beneficial in delivering a successful treatment by improving the Apnea Hypopnea Index and the subjective symptoms of patients with obstructive sleep apnea and snoring. In the future, dentists should be more proactive in detecting patients with obstructive sleep apnea and offering dental appliance therapy as a viable alternative to existing treatment options.