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Ready‐made versus custom‐made mandibular advancement appliances in obstructive sleep apnea: A systematic review and meta‐analysis
Author(s) -
Johal Ama,
Agha Bahn
Publication year - 2018
Publication title -
journal of sleep research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.297
H-Index - 117
eISSN - 1365-2869
pISSN - 0962-1105
DOI - 10.1111/jsr.12660
Subject(s) - confidence interval , medicine , obstructive sleep apnea , meta analysis , apnea–hypopnea index , randomized controlled trial , sleep apnea , physical therapy , clinical trial , systematic review , apnea , medline , polysomnography , political science , law
Summary Mandibular advancement appliances (MAAs) are an increasingly accepted treatment choice in obstructive sleep apnea management. The ready‐made MAAs has questioned the need for a customised MAAs, given the former is more accessible and considerably cheaper. We conducted a systematic review and meta‐analysis to evaluate both objective and patient‐centred outcomes in relation to ready‐made and custom‐made MAAs s. Biomedical electronic databases, clinical trials registers and Grey literature were searched to January 2017, for randomised controlled trials. Meta‐analyses of clinical trials were conducted for a range of objective (apnea–hypopnea index, treatment response) and subjective scales (daytime sleepiness; quality of life; patient preference and adherence). The review included three randomised controlled trials, which revealed low risk of bias. Custom‐made MAAs s achieved a significant mean difference in the apnea–hypopnea index (−3.2; 95% confidence interval −5.18, −1.22; p = .004), daytime sleepiness (−0.98; 95% confidence interval −1.97, 0.01; p = .05), observed mean difference in Functional Outcomes of Sleep Questionnaire scores (0.76; 95% confidence interval 0.14, 1.38; p = .02), self‐reported adherence (6.4–7 nights per week and 5–6.3 hr per night) and expressed preference ( p ≤ .001) when compared with the ready‐made MAAs s. Custom‐made MAAs s offer clear definable advantages, demonstrating significant clinical effectiveness, patient preference and adherence.