Efficacy of Mandibular Advancement Devices in the Treatment of Mild to Moderate Obstructive Sleep Apnea: A Systematic Review
Abstract
1. Introduction
1.1. Diagnosis
1.2. Treatment
1.3. Young Patients
2. Materials and Methods
2.1. Protocol and Registration
2.2. Search Processing
Article screening strategy |
Keywords: A: “mandibular advancement device” OR “mandibular advancement splint” OR “oral appliance” OR “dental appliance” OR “MAD” OR “MAS” B: “obstructive sleep apnea” OR “OSA” |
Boolean Indicators: “A” OR “B” |
Timespan: within 10 years |
Electronic databases: Pubmed; Scopus; Web of Science |
2.3. Inclusion Criteria
- Studies that investigated the use of MAD in patients suffering from OSA;
- Randomized clinical trials;
- Studies with open access written in English;
- Full-text articles;
- Studies that were published in the last 10 years.
2.4. Exclusion Criteria
- Animal studies;
- In vitro studies;
- Off-topic studies;
- Reviews, retrospective studies, case series and case reports, letters to the authors or comments;
- Non-English-language studies.
2.5. PICO Question
- Participants: Individuals with mild to moderate OSA, which was confirmed through overnight polysomnography (PSG). Participants: adults (≥18 y) with mild–moderate OSA (AHI 5–30 events/h) diagnosed by polysomnography or type-III HSAT Both male and female.
- Interventions: application of MAD
- Comparisons: different MAD in conservative management (no/standard care, lifestyle, positional) and alternative therapies (CPAP, surgery, weight loss).
- Outcomes: Treatment of OSA to improve quality of life and reduce the risk of cardiovascular complications, apnea-hypopnea index (AHI), oxygen saturation, and sleep quality.
2.6. Data Processing
2.7. Article Identification Procedure
2.8. Study Evaluation
2.9. Quality Assessment
3. Results
3.1. Study Selection and Characteristics
3.2. Quality Assessment and Risk of Bias
3.3. Clinical Outcomes
4. Discussion
4.1. Types and Mechanisms of Action of MAD
4.2. Clinical Efficacy and Predictive Factors
4.3. Translational Challenges: Tolerability, Adherence, and Multidisciplinary Care
4.4. Limitations of the Study and Future Research
5. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
Abbreviation | Definition |
OSA | Obstructive sleep apnea |
MAD | Mandibular advancement devices |
AHI | Apnea-hypopnea index |
ESS | Epworth Sleepiness Scale |
UA | Upper airway |
PSG | Polysomnography |
CPAP | Positive pressure airway devices |
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Authors (Year) | D1 | D2 | D3 | D4 | D5 | D6 | D7 | Overall |
Agarwal S.S et al., 2023 [103] | ||||||||
Bosschieter P.F.N. et al., 2022 [104] | ||||||||
Ciavarella D. et al., 2023 [105] | ||||||||
Fichera G. et al., 2020 [106] | ||||||||
On S.W. et al., 2024 [107] | ||||||||
Pahkala R. et al., 2020 [108] | ||||||||
Pitarch R.M. et al., 2018 [109] | ||||||||
Shete C.S. et al., 2017 [110] | ||||||||
Verburg F.E. et al., 2018 [111] | ||||||||
Zhu N. et al., 2024 [112] | ||||||||
Domains: D1: Bias due to confounding. D2: Bias arising from measurement of the exposure. D3: Bias in selection of participants into the study (or into the analysis). D4: Bias due to post-exposure interventions. D5: Bias due to missing data. D6: Bias arising from measurement of the outcome. D7: Bias in Selection of the Reported Result |
Authors | Number of Patients | Study Design | AHI (Pre/Post) | ESS (Pre/Post) | Other Parameters |
Agarwal S.S. et al., 2023 [103] | 30 (18 M, 12 F) | CPAP vs. MAD | Pre: 35 → Post: 25 | Pre: 12 → Post: 8 | Satisfaction higher in MAD vs. CPAP |
Bosschieter P.F.N. et al., 2022 [104] | 58 | Non-custom MAD vs. Custom MAD | Pre: 16.3 → Post: 10.7 (custom), Pre: 16.3 → Post: 7.8 (non-custom) | Pre-baseline: Not reported → Post: questionnaires indicated improvement post-treatment.” (p = 0.005) | Adherence improvement |
Ciavarella D. et al., 2023 [105] | 29 (15 M, 14 F) | Customizable MAD | Pre: 28 → Post: 16 | Pre: 15 → Post: 10 | ↑ SpO2, ↑ quality of life |
Fichera G. et al., 2020 [106] | 18 (15 M, 3 F) | MAD | Pre: 40 → Post: 35 | Pre: 16 → Post: 12 | MAD comparable to CPAP |
On S.W. et al., 2024 [107] | 14 (<20 years) | Autotitrating MAD | Pre: 32.8 → Post: 12.9 | Pre: 14 → Post: 9 | ↑ SpO2 minima |
Pahkala R. et al., 2020 [108] | 58 (39 M, 19 F) | MAD | Pre: 40 → Post: 25 | Pre: 16 → Post: 10 | Quality of life, snoring improvement |
Pitarch R.M. et al., 2018 [109] | 41 | MAD | Pre: 22.5 → Post: 9.1 | Pre: 12 → Post: 7 | Snoring index reduction |
Shete C.S. et al., 2017 [110] | 37 | MAD | Pre: 30 → Post: 20 | Pre: 15 → Post: 10 | ↑ Airway volume, ↑ SpO2 |
Verburg F.E. et al., 2018 [111] | 137 | MAD 1 vs. MAD 2 | No significant difference | Not reported | No significant difference in AHI |
Zhu N. et al., 2024 [112] | 20 | MAD | Pre: >30 → Post: 14.8 | Pre: 12 → Post: 10 | Symptom improvement with titration |
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Inchingolo, A.D.; Inchingolo, A.M.; Ciocia, C.; Calò, F.; Savastano, S.; Inchingolo, F.; Palermo, A.; Giudice, G.; Di Venere, D.; Marinelli, G.; et al. Efficacy of Mandibular Advancement Devices in the Treatment of Mild to Moderate Obstructive Sleep Apnea: A Systematic Review. Int. J. Transl. Med. 2025, 5, 49. https://doi.org/10.3390/ijtm5040049
Inchingolo AD, Inchingolo AM, Ciocia C, Calò F, Savastano S, Inchingolo F, Palermo A, Giudice G, Di Venere D, Marinelli G, et al. Efficacy of Mandibular Advancement Devices in the Treatment of Mild to Moderate Obstructive Sleep Apnea: A Systematic Review. International Journal of Translational Medicine. 2025; 5(4):49. https://doi.org/10.3390/ijtm5040049
Chicago/Turabian StyleInchingolo, Alessio Danilo, Angelo Michele Inchingolo, Claudia Ciocia, Francesca Calò, Sara Savastano, Francesco Inchingolo, Andrea Palermo, Giuseppe Giudice, Daniela Di Venere, Grazia Marinelli, and et al. 2025. "Efficacy of Mandibular Advancement Devices in the Treatment of Mild to Moderate Obstructive Sleep Apnea: A Systematic Review" International Journal of Translational Medicine 5, no. 4: 49. https://doi.org/10.3390/ijtm5040049
APA StyleInchingolo, A. D., Inchingolo, A. M., Ciocia, C., Calò, F., Savastano, S., Inchingolo, F., Palermo, A., Giudice, G., Di Venere, D., Marinelli, G., & Dipalma, G. (2025). Efficacy of Mandibular Advancement Devices in the Treatment of Mild to Moderate Obstructive Sleep Apnea: A Systematic Review. International Journal of Translational Medicine, 5(4), 49. https://doi.org/10.3390/ijtm5040049