Abstract | BACKGROUND: The effectiveness of intraoral appliances ( IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) in the treatment of children and adults with obstructive sleep apnea (OSA) has not yet been adequately assessed. METHODS: An umbrella review was performed based on established guidelines for evidence-based medicine. Data synthesis was performed only from randomized controlled trials with Paule-Mandel random-effects meta-analyses / meta-regressions using mean differences (MDs) and 95% confidence intervals (CIs) and was followed by the qualitative evaluation of the meta-evidence. RESULTS: 29 systematic reviews were included, 7 of which provided quantitative data. IOA were effective in improving apnea hypopnea index (AHI) compared to both, placebo appliances (12 trials; 525 patients; MD = -11.70; 95% CI: [-15.38; -8.01]; p<0.001) and no treatment (1 trial; 24 patients; MD = -14.30; [-21.59; -7.01]; p<0.001). Only the former comparison was supported by robust meta-evidence. Effectiveness of IOA as measured by the Epworth Sleepiness Scale, on the other hand, was not supported by robust meta-evidence. No randomized or prospective controlled trials were found on the effectiveness of ME (conventional or surgically assisted) and MMA. CONCLUSION: Intraoral appliances are effective in reducing AHI and their use is substantiated by robust evidence. There is no evidence from high-quality research to support treatment with ME (conventional or surgically assisted) or MMA in patients with OSA.
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Authors | Vasiliki Koretsi, Theodore Eliades, Spyridon N Papageorgiou |
Journal | Deutsches Arzteblatt international
(Dtsch Arztebl Int)
Vol. 115
Issue 12
Pg. 200-207
(03 23 2018)
ISSN: 1866-0452 [Electronic] Germany |
PMID | 29642990
(Publication Type: Journal Article, Review)
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Topics |
- Humans
- Orthodontic Appliances
- Palatal Expansion Technique
- Sleep Apnea, Obstructive
(therapy)
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