Predictors of Success in the Treatment of Obstructive Sleep Apnea Syndrome with Mandibular Repositioning Appliance: A Systematic Review

Abstract

Introduction Obstructive sleep apnea syndrome affects up to 4% of middle-aged men and 2% of adult women. It is associated with obesity.

Objective The objective of this article is to review the literature to determine which factors best correlate with treatment success in patients with obstructive sleep apnea syndrome treated with a mandibular repositioning appliance.

Data Synthesis A search was performed of the PubMed, Cochrane, Lilacs, Scielo, and Web of Science databases of articles published from January 1988 to January 2012. Two review authors independently collected data and assessed trial quality. Sixty-nine articles were selected from PubMed and 1 from Cochrane library. Of these, 42 were excluded based on the title and abstract, and 27 were retrieved for complete reading. A total of 13 articles and 1 systematic review were considered eligible for further review and inclusion in this study: 6 studies evaluated anthropomorphic and physiologic factors, 3 articles addressed cephalometric and anatomic factors, and 4 studies evaluated variables related to mandibular repositioning appliance design and activation. All the studies evaluated had low to moderate methodologic quality and were not able to support evidence on prediction of treatment success.

Conclusion Based on this systematic review on obstructive sleep apnea syndrome treatment, it remains unclear which predictive factors can be used with confidence to select patients suitable for treatment with a mandibular repositioning appliance.

Keywords

systematic review - sleep apnea syndrome - obstructive sleep apnea syndrome

• References

• 1 Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22 (5) 667-689
• 2 Berry RB, Budhiraja R, Gottlieb DJ , et al; American Academy of Sleep Medicine; Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. J Clin Sleep Med 2012; 8 (5) 597-619
• 3 Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA. Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study. Sleep Med 2010; 11 (5) 441-446
• 4 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328 (17) 1230-1235
• 5 Lim J, Lasserson TJ, Fleetham J, Wright J. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 2006; (1) CD004435
• 6 Sateia MJ. Neuropsychological impairment and quality of life in obstructive sleep apnea. Clin Chest Med 2003; 24 (2) 249-259
• 7 Alchanatis M, Zias N, Deligiorgis N, Amfilochiou A, Dionellis G, Orphanidou D. Sleep apnea-related cognitive deficits and intelligence: an implication of cognitive reserve theory. J Sleep Res 2005; 14 (1) 69-75
• 8 Shahar E, Whitney CW, Redline S , et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163 (1) 19-25
• 9 Marin JM, Carrizo SJ, Vicente E, Agusti AGN. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 (9464) 1046-1053
• 10 Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 2008; 31 (8) 1079-1085
• 11 Freedman N. Treatment of obstructive sleep apnea syndrome. Clin Chest Med 2010; 31 (2) 187-201
• 12 American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD-2). 2nd ed. Westchester, IL, USA: American Academy of Sleep Medicine; 2005
• 13 Chaves Junior CM, Dal-Fabbro C, de Bruin VMS, Tufik S, Bittencourt LRA. Brazilian consensus of snoring and sleep apnea—aspects of interest for orthodontists. Dental Press J Orthod 2011; 16: e1-e10
• 14 Lacasse Y, Bureau MP, Sériès F. A new standardised and self-administered quality of life questionnaire specific to obstructive sleep apnoea. Thorax 2004; 59 (6) 494-499
• 15 Esposito M, Worthington HV, Coulthard P. In search of truth: the role of systematic reviews and meta-analyses for assessing the effectiveness of rehabilitation with oral implants. Clin Implant Dent Relat Res 2001; 3 (2) 62-78
• 16 Roccuzzo M, Bunino M, Needleman I, Sanz M. Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review. J Clin Periodontol 2002; 29 (Suppl. 03) 178-194 , discussion 195–196
• 17 Barnes M, McEvoy RD, Banks S , et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 2004; 170 (6) 656-664
• 18 Engleman HM, McDonald JP, Graham D , et al. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 2002; 166 (6) 855-859
• 19 Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LGM. Obstructive sleep apnea therapy. J Dent Res 2008; 87 (9) 882-887
• 20 Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001; 163 (6) 1457-1461
• 21 Tan YK, L'Estrange PR, Luo Y-M , et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod 2002; 24 (3) 239-249
• 22 Wilhelmsson B, Tegelberg A, Walker-Engström ML , et al. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol 1999; 119 (4) 503-509
• 23 Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration 2011; 81 (5) 411-419
• 24 Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration 2011; 82 (2) 162-168
• 25 Pitsis AJ, Darendeliler MA, Gotsopoulos H, Petocz P, Cistulli PA. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 2002; 166 (6) 860-864
• 26 Gagnadoux F, Fleury B, Vielle B , et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J 2009; 34 (4) 914-920
• 27 Petri N, Svanholt P, Solow B, Wildschiødtz G, Winkel P. Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res 2008; 17 (2) 221-229
• 28 Tegelberg A, Walker-Engström ML, Vestling O, Wilhelmsson B. Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea. Acta Odontol Scand 2003; 61 (6) 356-362
• 29 Walker-Engström ML, Ringqvist I, Vestling O, Wilhelmsson B, Tegelberg A. A prospective randomized study comparing two different degrees of mandibular advancement with a dental appliance in treatment of severe obstructive sleep apnea. Sleep Breath 2003; 7 (3) 119-130
• 30 Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995; 18 (6) 501-510
• 31 O'Sullivan RA, Hillman DR, Mateljan R, Pantin C, Finucane KE. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995; 151 (1) 194-198
• 32 Lowe A, Fleetham J, Ryan F, Mathews B. Effects of a mandibular repositioning appliance used in the treatment of obstructive sleep apnea on tongue muscle activity. Prog Clin Biol Res 1990; 345: 395-404 , discussion 405
• 33 Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP. Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 1994; 149 (4 Pt 1) 905-909
• 34 Millman RP, Rosenberg CL, Carlisle CC, Kramer NR, Kahn DM, Bonitati AE. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty. Chest 1998; 113 (4) 992-996
• 35 Bloch KE, Iseli A, Zhang JN , et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med 2000; 162 (1) 246-251
• 36 Rose EC, Staats R, Lehner M, Jonas IE. Cephalometric analysis in patients with obstructive sleep apnea. Part I: diagnostic value. J Orofac Orthop 2002; 63 (2) 143-153
• 37 Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 2006; 29 (2) 244-262
• 38 Liu Y, Lowe AA, Fleetham JA, Park Y-C. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001; 120 (6) 639-647
• 39 Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004; 125 (4) 1270-1278
• 40 Randerath WJ, Heise M, Hinz R, Ruehle KH. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest 2002; 122 (2) 569-575
• 41 Ahrens A, McGrath C, Hägg U. Subjective efficacy of oral appliance design features in the management of obstructive sleep apnea: a systematic review. Am J Orthod Dentofacial Orthop 2010; 138 (5) 559-576