HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Fig. 1. Flow diagram. AHI 5 apnea/ hypopnea index; MAD 5 mandibular advancement device. [Color figure can be viewed in the online issue, which is available at www.laryngo- scope.com.]

A noninvasive alternative is to use oral mandibular advancement devices (MADs). 9,10 Although less effective than CPAP, 11–15 they present fewer side effects, better tolerance, and greater personal satisfaction. Although some authors consider that their use should be limited to mild and moderate OSAHS, 12,16,17 others also advo- cate this treatment for severe OSAHS cases. 18–21 A sys- tematic review by Lim et al. 22 concluded that MADs would be an appropriate recommendation for patients with mild OSAHS symptoms and for those who had diffi- culty in tolerating CPAP. MADs are classified as adjustable when they con- tain a mechanism by which to increase the degree of mandibular advancement, or fixed when they are manu- factured in a fixed position (generally between 60% and 80% of maximum mandibular protrusion). They can be prefabricated or custom made 23 and can also be monobloc or duobloc, depending on whether the MAD is composed of one or two pieces. 24 The purpose of this review was to examine the sci- entific evidence concerning the effectiveness of MADs in treating OSAHS. The objectives of the systematic review were: 1) to assess the effectiveness of different MADs in treating OSAHS, based on the main objective polysom- nographic measurements, such as AHI and oxygen satu- ration, as well as on changes in the upper airway and

improvements in symptoms such as snoring and daytime sleepiness; and 2) to assess the most frequent adverse effects in relation to the use of MADs.

MATERIALS AND METHODS A systematic review of the bibliography was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations and CONSORT criteria. 25 Study Selection Criteria The selection criteria for the articles to be included in the review were as follows. The article types accepted were “articles,” “articles in press,” and “reviews” concerning studies conducted in adults. Only the following types of study were accepted: systematic reviews and meta-analyses, randomized clinical trials, cohort studies, and case–control studies, both pro- spective and retrospective. All such studies of treating OSAHS with different MADs were included. Search Strategy and Screening of Articles To identify the relevant studies, irrespective of language, a detailed electronic search was carried out in the Medline, Sco- pus, and Cochrane Library databases. All studies published between 2004 and 2014 were included.

Laryngoscope 126: February 2016

Serra-Torres et al.: Oral Appliances for Sleep Apnea

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