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Article

The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

1
Department of Oral Surgery, Hironokogen Hospital, 3-1-1 Kitayamadai Nishi-ku Kobe-shi, Hyogo 6512215, Japan
2
Department of Oral and Maxillofacial Surgery, Aichi Medical University, 1-1 Yazakokarimata Nagakute-shi, Aichi 4801103, Japan
3
Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College. 2-7 Daigaku-machi Takatsuki-shi, Osaka 5698686, Japan
4
Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 1138510, Japan
5
Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-Dori, Cyuo-ku, Nigata-shi, Nigata 9518514, Japan
6
Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano Ichikawa-shi, Chiba 2728513, Japan
7
Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, 50 Imure-chou Aza Hamamichi-Ue, Toyohashi-shi, Aichi 4408510, Japan
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2019, 16(18), 3248; https://doi.org/10.3390/ijerph16183248
Received: 30 July 2019 / Revised: 28 August 2019 / Accepted: 30 August 2019 / Published: 4 September 2019
(This article belongs to the Special Issue Sleep Apnea Syndrome)
This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed. View Full-Text
Keywords: oral appliance; mandibular protrusion; obstructive sleep apnea; systematic review oral appliance; mandibular protrusion; obstructive sleep apnea; systematic review
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MDPI and ACS Style

Sakamoto, Y.; Furuhashi, A.; Komori, E.; Ishiyama, H.; Hasebe, D.; Sato, K.; Yuasa, H. The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review. Int. J. Environ. Res. Public Health 2019, 16, 3248. https://doi.org/10.3390/ijerph16183248

AMA Style

Sakamoto Y, Furuhashi A, Komori E, Ishiyama H, Hasebe D, Sato K, Yuasa H. The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review. International Journal of Environmental Research and Public Health. 2019; 16(18):3248. https://doi.org/10.3390/ijerph16183248

Chicago/Turabian Style

Sakamoto, Yuki, Akifumi Furuhashi, Eri Komori, Hiroyuki Ishiyama, Daichi Hasebe, Kazumichi Sato, and Hidemichi Yuasa. 2019. "The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review" International Journal of Environmental Research and Public Health 16, no. 18: 3248. https://doi.org/10.3390/ijerph16183248

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