Mandibular advancement splint (MAS) therapy for obstructive sleep apnoea—an overview and quality assessment of systematic reviews

• Published in: Sleep & breathing Vol. 19; no. 3; pp. 1101 - 1108
• Main Authors: Johal, Ama, Fleming, Padhraig S., Manek, Seema, Marinho, Valeria C. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2015; Springer Nature B.V
• Subjects: Adult; Clinical outcomes; Dentistry; Disorders of Excessive Somnolence - therapy; Humans; Internal Medicine; Mandibular Advancement - instrumentation; Medical equipment; Medical treatment; Medicine; Medicine & Public Health; Neurology; Occlusal Splints; Otorhinolaryngology; Pediatrics; Pneumology/Respiratory System; Polysomnography; Review; Sleep apnea; Sleep Apnea, Obstructive - therapy; Sleep apnoea; Systematic review; Mandibular appliance
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-015-1148-4

Background To conduct an overview of existing systematic reviews concerning management of obstructive sleep apnoea-hypopnoea syndrome (OSAHS) with mandibular advancement splint (MAS) and assess their methodological quality. Method PubMed and relevant Cochrane Library databases (CDSR, DARE, HTA) searches were performed (09.13) to identify systematic reviews investigating the response of adults with OSAHS to MAS therapy. The methodological quality of the included systematic reviews was assessed using AMSTAR, a validated tool for assessing quality. Results Eight systematic reviews, four incorporating meta-analyses, were identified evaluating both objective and subjective outcome measures. The effectiveness of MAS therapy was compared to no treatment ( n  = 1), non-active appliance ( n  = 6), continuous positive airway pressure (CPAP; n  = 5), surgical intervention ( n  = 3) and a different MAS intervention ( n  = 4). The quality of the reviews was variable (median = 7, range = 3 to 11), with only two of higher quality (AMSTAR scores >10), one of them a Cochrane review. In this high quality and current review, the overall (pooled) effects for comparison of MAS therapy with inactive appliances, revealed significant benefits of MAS therapy in terms of both daytime sleepiness and objective apnoea-hypopnoea index (AHI) outcomes. Conclusion In general, the results from the higher quality reviews concerning the effectiveness of MAS therapy for OSAHS highlight the ability of the intervention to improve OSAHS. Current reporting guidelines for systematic reviews (e.g. PRISMA) and sources of high-quality existing reviews should be closely followed to enhance the validity and relevance of future reviews.