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Meta-Analysis
. 2024 Jun 7;24(1):666.
doi: 10.1186/s12903-024-04277-8.

Oral appliance therapy vs. positional therapy for managing positional obstructive sleep apnea; a systematic review and meta-analysis of randomized control trials

Abdelrahman Ma Mohamed  1   2 , Omar Magdy Mohammed  3 , Shanshan Liu  4 , Maher Al-Balaa  5 , Leena Ali Al-Warafi  4 , Song Juan Peng  4 , Yi Qiang Qiao  6
Affiliations
Meta-Analysis

Oral appliance therapy vs. positional therapy for managing positional obstructive sleep apnea; a systematic review and meta-analysis of randomized control trials

Abdelrahman Ma Mohamed et al. BMC Oral Health. .

Abstract

Aim: To assess the efficacy of positional therapy and oral appliance therapy for the management of positional obstructive sleep apnea.

Methods: We searched PubMed, Web of Science, Cochrane, and SCOPUS for relevant clinical trials. Quality assessment of the included trials was evaluated according to Cochrane's risk of bias tool. We included the following outcomes: The apnea-hypopnea index (AHI), AHI non-supine, AHI supine, sleep efficiency, percentage of supine sleep, Adherence (≥ 4 h/night, ≥ 5 days/week), Oxygen desaturation Index, Arousal Index, Epworth Sleepiness Scale score (ESS), Mean SpO2, and Functional Outcomes of Sleep Questionnaire.

Results: The AHI non-supine and the ESS scores were significantly lower in the OAT cohort than in the PT cohort. The PT cohort was associated with a significantly decreased percentage of supine sleep than the OAT cohort (MD= -26.07 [-33.15, -19.00], P = 0.0001). There was no significant variation between PT cohort and OAT cohort regarding total AHI, AHI supine, ODI, sleep efficiency, arousal index, FOSQ, adherence, and mean SpO2.

Conclusion: Both Positional Therapy and Oral Appliance Therapy effectively addressed Obstructive Sleep Apnea. However, Oral Appliance Therapy exhibited higher efficiency, leading to increased supine sleep percentage and more significant reductions in the Apnea Hypopnea Index during non-supine positions, as well as lower scores on the Epworth Sleepiness Scale.

Keywords: Mandibular advancement device therapy; Obstructive sleep apnea; Oral appliance therapy; Positional therapy; Sleep position trainer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Shows a PRISMA flow diagram of our literature search
Fig. 2
Fig. 2
Summary of the risk of bias of included studies
Fig. 3
Fig. 3
Heterogeneity and overall effect of total AHI that does not favor any of both groups
Fig. 4
Fig. 4
Heterogeneity and the overall effect of AHI supine that does not favor any of both groups
Fig. 5
Fig. 5
Heterogeneity and the overall effect of AHI non-supine that favors the OAT group
Fig. 6
Fig. 6
Heterogeneity and the overall effect of Oxygen desaturation index that does not favor any of both groups
Fig. 7
Fig. 7
Heterogeneity and the overall effect of Percentage of supine sleep that favors the OAT group
Fig. 8
Fig. 8
Heterogeneity and overall effect of sleep efficiency that does not favor any of both groups
Fig. 9
Fig. 9
Heterogeneity and overall effect of the Arousal index that does not favor any of both groups
Fig. 10
Fig. 10
Heterogeneity and the overall effect of the Epworth Sleepiness Scale (ESS) score that favors the OAT group
Fig. 11
Fig. 11
Heterogeneity and overall effect of Functional outcomes of sleep questionnaire (FOSQ) that does not favor any of both groups
Fig. 12
Fig. 12
Heterogeneity and overall effect of Adherence that does not favor any of both groups
Fig. 13
Fig. 13
Heterogeneity and overall effect of Mean SpO2 that does not favor any of both groups
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References

    1. Chang H, Chen Y, Du J. Obstructive sleep apnea treatment in adults. Kaohsiung J Med Sci. 2020;36(1):7–12. doi: 10.1002/kjm2.12130. - DOI - PMC - PubMed
    1. Johnson KG. Obstructive sleep apnea. CONTINUUM: Lifelong Learn Neurol. 2023;29(4):1071–91. - PubMed
    1. Hizal M, Satırer O, Polat SE, et al. Obstructive sleep apnea in children with Down syndrome: is it possible to predict severe apnea? Eur J Pediatrics. 2022;181(2):735–43. doi: 10.1007/s00431-021-04267-w. - DOI - PMC - PubMed
    1. Xu L, Keenan BT, Wiemken AS, et al. Differences in three-dimensional upper airway anatomy between Asian and European patients with obstructive sleep apnea. Sleep. 2020;43(5):zsz273. doi: 10.1093/sleep/zsz273. - DOI - PMC - PubMed
    1. Mohamed AMA, Chen Y, Wafaie K, et al. Cephalometric evaluation of posterior airway space in Chinese and Egyptian races. APOS. 2023;13:205–14. doi: 10.25259/APOS_17_2023. - DOI

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