Sleep Apnea Treatment Review
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Questions and Answers

What is the most commonly used non-continuous positive airway pressure treatment for obstructive sleep apnea?

Mandibular advancement device (MAD)

Which characteristics were found in responders to MAD therapy according to the meta-analysis mentioned?

  • Lower age, female, lower body mass index (correct)
  • Higher age, male, higher body mass index
  • Smaller neck circumference, retracted maxilla, higher CPAP compliance
  • Wider airway, shorter soft palate, higher AHI

    • Mandibular advancement device (MAD) therapy can prevent upper airway collapse by protruding the __________ to reduce upper airway collapsibility.

    mandible

    Compliance with Continuous Positive Airway Pressure (CPAP) therapy is often very high.

    <p>False</p> Signup and view all the answers

    Match the following abbreviations with their full forms:

    <p>AHI = Apnea-hypopnea index BMI = Body mass index CPAP = Continuous positive airway pressure PSG = Polysomnography</p> Signup and view all the answers

    What is the main purpose of a PICOS search strategy in a research study?

    <p>To identify the Population/Patient, Intervention, Comparison, Outcome, and Study design</p> Signup and view all the answers

    Which databases were included in the electronic search strategy for the study?

    <p>Scopus</p> Signup and view all the answers

    The PICOS search strategy stands for Population/Patient, Intervention, Comparison, Outcome, and ____________.

    <p>Study design</p> Signup and view all the answers

    One of the studies found that responders to MAD therapy have a smaller inferior airway space than non-responders.

    <p>False</p> Signup and view all the answers

    Study Notes

    Obstructive Sleep Apnea (OSA) and Mandibular Advancement Device (MAD) Therapy

    • OSA is a sleep-related breathing disorder characterized by recurrent episodes of partial or complete upper-airway obstruction during sleep.
    • It is associated with oxygen desaturations and arousals from sleep, and has serious long-term consequences if left untreated.

    Treatment of OSA

    • Continuous Positive Airway Pressure (CPAP) is the gold standard treatment for OSA, but compliance with CPAP therapy is often poor.
    • Mandibular Advancement Device (MAD) therapy is a non-CPAP treatment for OSA, which prevents upper airway collapse by protruding the mandible to reduce upper airway collapsibility.

    Phenotypes of Responders to MAD Therapy

    • Responders to MAD therapy have certain clinical phenotypic characteristics, including lower age, female, lower body mass index (BMI), smaller neck circumference, lower apnea-hypopnea index (AHI), and specific craniofacial features.
    • Responders have a smaller inferior airway space (IAS) compared to non-responders in some studies, but not all studies agree on this finding.

    Systematic Review and Meta-Analysis

    • The systematic review and meta-analysis aimed to describe the baseline phenotypic characteristics of responders to MAD therapy in OSA patients.
    • A total of 41 studies were included in the review, with six studies assessing clinical characteristics, 20 studies assessing craniofacial characteristics, five studies assessing PSG characteristics, and 10 studies assessing physiological characteristics.
    • The quality of the studies was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS).

    Results of the Systematic Review and Meta-Analysis

    • The responders to MAD therapy have lower age, female, lower BMI, smaller neck circumference, lower AHI, and specific craniofacial features compared to non-responders.

    • The results provide useful information for clinicians considering prescribing MAD therapy for OSA patients.### Search Terminology

    • 29,214 results found for "obstructive sleep apnea" on Medline (PubMed)

    • 33,691 results found for "obstructive sleep apnea" on Excerpta Medica database (EMBASE)

    • 34,166 results found for "obstructive sleep apnea" on Web of Science

    • 72,440 results found for "obstructive sleep apnea" on Scopus

    • 699 results found for "mandibular advancement device or mandibular advancement splint or oral appliance or mandibular repositioning device" on Medline (PubMed)

    • 1301 results found for "mandibular advancement device or mandibular advancement splint or oral appliance or mandibular repositioning device" on Excerpta Medica database (EMBASE)

    • 2890 results found for "mandibular advancement device or mandibular advancement splint or oral appliance or mandibular repositioning device" on Web of Science

    • 814 results found for "mandibular advancement device or mandibular advancement splint or oral appliance or mandibular repositioning device" on Scopus

    • 1,888,926 results found for "predict or prediction or compare or comparison" on Medline (PubMed)

    • 3,262,136 results found for "predict or prediction or compare or comparison" on Excerpta Medica database (EMBASE)

    • 8,770,398 results found for "predict or prediction or compare or comparison" on Web of Science

    • 15,072,914 results found for "predict or prediction or compare or comparison" on Scopus

    • 172 results found for "#1 and #2 and #4" on Medline (PubMed)

    • 208 results found for "#1 and #2 and #4" on Excerpta Medica database (EMBASE)

    • 229 results found for "#1 and #2 and #4" on Web of Science

    • 304 results found for "#1 and #2 and #4" on Scopus

    Study Characteristics

    • 41 studies were selected for quality assessment
    • 17 retrospective studies were identified, indicating high risk of bias in participant selection
    • 28 studies did not conduct adequate blinding of outcome measurements, leading to high risk of detection bias
    • 2 studies did not provide enough information on potential confounding factors, contributing to selection bias
    • Different types of mandibular advancement devices (MADs) were used in 2 studies, causing high risk of performance bias
    • Mandibular position varied between selected studies, including maximum comfortable protrusion position, 70-80% protrusion position, and 60% maximum protrusion position
    • Maximum comfortable protrusion position was the most commonly used treatment position for OSA patients
    • 4 studies were considered to have high risk regarding attrition bias
    • Definition of responders to MAD in OSA patients varied among different studies
    • Most frequently used definition is post-treatment AHI ≤ 10

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    Description

    Explore the different phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients through a systematic review and meta-analysis.

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