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Intraoral appliances effectively reduce the apnea hypopnea index in obstructive sleep apnea patients. However, robust evidence does not support maxillary expansion or maxillomandibular advancement for OSA treatment.

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Area of Science:

  • Sleep Medicine
  • Otolaryngology
  • Dental Sleep Medicine

Background:

  • Obstructive sleep apnea (OSA) is a prevalent condition affecting both children and adults.
  • The efficacy of various oral appliances for OSA treatment requires thorough assessment.
  • Intraoral appliances (IOA), maxillary expansion (ME), and maxillomandibular advancement (MMA) are potential treatment modalities.

Purpose of the Study:

  • To systematically evaluate the evidence for IOA, ME, and MMA in treating OSA.
  • To synthesize data from high-quality randomized controlled trials (RCTs).
  • To provide evidence-based recommendations for OSA management.

Main Methods:

  • An umbrella review methodology was employed, adhering to evidence-based medicine guidelines.
  • Data synthesis focused on RCTs, utilizing random-effects meta-analyses and meta-regressions.
  • Qualitative evaluation of meta-evidence was conducted to assess the robustness of findings.

Main Results:

  • Intraoral appliances significantly improved the apnea hypopnea index (AHI) compared to placebo appliances (MD = -11.70) and no treatment (MD = -14.30).
  • Robust meta-evidence supported IOA effectiveness against placebo appliances.
  • No high-quality RCTs were identified for the effectiveness of maxillary expansion or maxillomandibular advancement in OSA patients.

Conclusions:

  • Intraoral appliances are a proven effective treatment for reducing AHI in OSA patients, supported by robust evidence.
  • Current high-quality research does not substantiate the use of maxillary expansion or maxillomandibular advancement for OSA treatment.
  • Further research is needed to explore the potential benefits and limitations of ME and MMA in specific OSA populations.