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. 2025 Sep 1;21(9):1611-1625.
doi: 10.5664/jcsm.11730.

Efficacy of advancement treatments of the stomatognathic system on objective sleepiness in OSA: a systematic review

Paul Galvez  1   2   3 , Emmanuel d'Incau  1   4   5 , Jacques Taillard  4 , Vincent P Martin  4   6 , Maria Clotilde Carra  7   8 , Mathilde Fenelon  2   3 , Virginie Chuy  5   9 , Julien Coelho  1   4 , Pierre Philip  1   4 , Jean-Arthur Micoulaud-Franchi  1   4
Affiliations

Efficacy of advancement treatments of the stomatognathic system on objective sleepiness in OSA: a systematic review

Paul Galvez et al. J Clin Sleep Med. .

Abstract

Study objectives: Objective sleepiness is an important outcome requiring rigorous evaluation regarding obstructive sleep apnea (OSA) treatment efficacy, but no systematic review has explored the efficacy of advancement treatments of the stomatognathic system (ie, mandibular advancement device [MAD], hypoglossal nerve stimulation, and maxillomandibular advancement surgery) on objective sleepiness in OSA.

Methods: We conducted a systematic review of the literature using PubMed, Scopus, and Web of Science databases. All clinical studies assessing the efficacy of advancement treatments of the stomatognathic system on objective sleepiness in adults with OSA by the Maintenance of Wakefulness Test, the Multiple Sleep Latency Test, the Oxford Sleep Resistance Test, the Psychomotor Vigilance Task, or the Sustained Attention to Response Task were included.

Results: Among 42 screened studies, 11 were included (6 randomized controlled trials [RCTs] and 5 prospective studies). Regarding the RCTs, all assessed MAD efficacy, and only 1 RCT found a significant improvement of objective sleepiness for MAD compared with placebo, on the Multiple Sleep Latency Test. In the remaining RCTs, the included participants did not present objective sleepiness at baseline and most had mild/moderate OSA. Regarding the prospective studies, all found a significant improvement of objective sleepiness for each treatment assessed (ie, MAD, hypoglossal nerve stimulation, maxillomandibular advancement surgery, and submental stimulation). Interestingly, the included participants in the prospective studies presented objective sleepiness at baseline and moderate/severe OSA.

Conclusions: This systematic review highlighted the lack of RCTs assessing the efficacy of MAD or other advancement treatments of the stomatognathic system on objective sleepiness in OSA. Further RCTs are needed to address this important outcome, taking into account baseline objective sleepiness and OSA severity.

Citation: Galvez P, d'Incau E, Taillard J, et al. Efficacy of advancement treatments of the stomatognathic system on objective sleepiness in OSA: a systematic review. J Clin Sleep Med. 2025;21(9):1611-1625.

Keywords: Maintenance of Wakefulness Test; alertness; excessive daytime sleepiness; hypoglossal nerve stimulation; mandibular advancement device; maxillomandibular advancement; objective sleepiness; obstructive sleep apnea.

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Conflict of interest statement

All authors have seen and approved the manuscript. Work for this study was performed at the University of Bordeaux, France. The authors declare no conflicts of interest.

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