TY - JOUR
T1 - Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients
T2 - A systematic review and meta-analysis
AU - Chen, Hui
AU - Eckert, Danny J.
AU - van der Stelt, Paul F.
AU - Guo, Jing
AU - Ge, Shaohua
AU - Emami, Elham
AU - Almeida, Fernanda R.
AU - Huynh, Nelly T.
PY - 2020/2
Y1 - 2020/2
N2 - Mandibular advancement device (MAD) therapy is the most commonly used non-continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). Although OSA patients prefer MAD over CPAP, on average over one third have minimal or no major reduction in OSA severity with MAD therapy. Improved understanding of responder characteristics (or “phenotypes”) to MAD may facilitate more efficient use of limited medical resources and optimize treatment efficacy. The aim of this review is to describe the baseline phenotypic characteristics of responders to MAD therapy in OSA patients. Pubmed, Web of Science, EMBASE, Scopus were searched for eligible studies published until Feb 2019. A total of 650 studies were identified. 41 studies were included in this review and meta-analysis. The quality of the studies was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS). Based on meta-analysis, the responders to MAD therapy had certain clinical phenotypic characteristics: lower age (95% CI: −4.55 to −1.62, p < 0.00001), female (95% CI: 0.56 to 0.91, p = 0.006), lower body mass index (95% CI: −2.80 to −1.11, p < 0.00001), smaller neck circumference (95% CI: −1.57 to −0.52, p < 0.00001), lower apnea-hypopnea index (95% CI: −7.23 to −1.89, p < 0.00001), a retracted maxilla and mandible, a narrower airway and a shorter soft palate than non-responders. The above-mentioned phenotypic responder characteristics provides useful information for the clinician when considering prescribing MAD therapy for OSA patients.
AB - Mandibular advancement device (MAD) therapy is the most commonly used non-continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). Although OSA patients prefer MAD over CPAP, on average over one third have minimal or no major reduction in OSA severity with MAD therapy. Improved understanding of responder characteristics (or “phenotypes”) to MAD may facilitate more efficient use of limited medical resources and optimize treatment efficacy. The aim of this review is to describe the baseline phenotypic characteristics of responders to MAD therapy in OSA patients. Pubmed, Web of Science, EMBASE, Scopus were searched for eligible studies published until Feb 2019. A total of 650 studies were identified. 41 studies were included in this review and meta-analysis. The quality of the studies was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS). Based on meta-analysis, the responders to MAD therapy had certain clinical phenotypic characteristics: lower age (95% CI: −4.55 to −1.62, p < 0.00001), female (95% CI: 0.56 to 0.91, p = 0.006), lower body mass index (95% CI: −2.80 to −1.11, p < 0.00001), smaller neck circumference (95% CI: −1.57 to −0.52, p < 0.00001), lower apnea-hypopnea index (95% CI: −7.23 to −1.89, p < 0.00001), a retracted maxilla and mandible, a narrower airway and a shorter soft palate than non-responders. The above-mentioned phenotypic responder characteristics provides useful information for the clinician when considering prescribing MAD therapy for OSA patients.
KW - Mandibular advancement device
KW - Meta-analysis
KW - Obstructive sleep apnea
KW - Phenotype
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85075510052&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1116942
U2 - 10.1016/j.smrv.2019.101229
DO - 10.1016/j.smrv.2019.101229
M3 - Review article
C2 - 31785583
AN - SCOPUS:85075510052
SN - 1087-0792
VL - 49
JO - Sleep Medicine Reviews
JF - Sleep Medicine Reviews
M1 - 101229
ER -