Abstract：
The meta-analysis aimed to evaluate the efficacy of mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA) and explore the effect of different positions on MAD for OSA.
The Embase, PubMed, Medline, and Cochrane Library databases were searched for relevant studies evaluating the effect of MAD on the treatment of OSA from database inception to November 2022. The Bayesian random-effects mode was used to calculate the pooled outcome. Subgroup analysis and sensitivity analysis were applied to investigate the heterogeneity.
A total of 6 studies enrolling 643 patients were eligible for further analysis. MAD treatment led to improvements in total apnea-hypopnea index (AHI) for both positional OSA(POSA) and Non-POSA groups, but there was no significant difference in the effect of MAD on Non-POSA and POSA (MD = -1.46,95%CI [-4.89,1.97], P = 0.40). In the supine position, AHI improvement after MAD treatment in POSA group was more than that in Non-POSA group by 15 events/hour in average (MD = 14.82, 95%CI [11.43,18.22], P＜0.00001), while in the non-supine position, the change of AHI in Non-POSA group was significantly better than that in POSA group by approximately 8 events/hour (MD = -7.55,95%CI[-10.73,-4.38],p < 0.00001).
MAD is more suitable for POSA compared to Non-POSA in patients with habitual sleep in the supine or supine predominant position. While for patients with habitual sleep in the non-supine position, MAD is an effective treatment option for Non-POSA.
The Embase, PubMed, Medline, and Cochrane Library databases were searched for relevant studies evaluating the effect of MAD on the treatment of OSA from database inception to November 2022. The Bayesian random-effects mode was used to calculate the pooled outcome. Subgroup analysis and sensitivity analysis were applied to investigate the heterogeneity.
A total of 6 studies enrolling 643 patients were eligible for further analysis. MAD treatment led to improvements in total apnea-hypopnea index (AHI) for both positional OSA(POSA) and Non-POSA groups, but there was no significant difference in the effect of MAD on Non-POSA and POSA (MD = -1.46,95%CI [-4.89,1.97], P = 0.40). In the supine position, AHI improvement after MAD treatment in POSA group was more than that in Non-POSA group by 15 events/hour in average (MD = 14.82, 95%CI [11.43,18.22], P＜0.00001), while in the non-supine position, the change of AHI in Non-POSA group was significantly better than that in POSA group by approximately 8 events/hour (MD = -7.55,95%CI[-10.73,-4.38],p < 0.00001).
MAD is more suitable for POSA compared to Non-POSA in patients with habitual sleep in the supine or supine predominant position. While for patients with habitual sleep in the non-supine position, MAD is an effective treatment option for Non-POSA.
摘要：
目的：本Meta分析旨在评价下颌前移装置（MAD）治疗阻塞性睡眠呼吸暂停（OSA）的疗效，并探讨不同体位对MAD的影响。
方法：Embase，PubMed,Medline,和CochraneLibrary数据库检索相关研究,评估从数据库开始到2022年11月MAD对OSA治疗的影响.贝叶斯随机效应模式用于计算合并结果。应用亚组分析和敏感性分析研究异质性。
结果：共有6项研究纳入643名患者，符合进一步分析的条件。MAD治疗可改善位置性OSA（POSA）和非POSA组的总呼吸暂停低通气指数（AHI），但是MAD对非POSA和POSA的影响没有显着差异（MD=-1.46,95CI[-4.89,1.97]，P=0.40）。仰卧位,POSA组MAD治疗后AHI改善高于非POSA组平均15个事件/小时(MD=14.82,95CI[11.43,18.22],P＜0.00001），在非仰卧位时，Non-POSA组AHI变化显著优于POSA组8次/小时(MD=-7.55,95CI[-10.73,-4.38],p<0.00001)。
结论：MAD比非POSA更适用于仰卧位或仰卧位为主的习惯性睡眠患者。而对于非仰卧位习惯性睡眠的患者，MAD是非POSA的有效治疗选择。
方法：Embase，PubMed,Medline,和CochraneLibrary数据库检索相关研究,评估从数据库开始到2022年11月MAD对OSA治疗的影响.贝叶斯随机效应模式用于计算合并结果。应用亚组分析和敏感性分析研究异质性。
结果：共有6项研究纳入643名患者，符合进一步分析的条件。MAD治疗可改善位置性OSA（POSA）和非POSA组的总呼吸暂停低通气指数（AHI），但是MAD对非POSA和POSA的影响没有显着差异（MD=-1.46,95CI[-4.89,1.97]，P=0.40）。仰卧位,POSA组MAD治疗后AHI改善高于非POSA组平均15个事件/小时(MD=14.82,95CI[11.43,18.22],P＜0.00001），在非仰卧位时，Non-POSA组AHI变化显著优于POSA组8次/小时(MD=-7.55,95CI[-10.73,-4.38],p<0.00001)。
结论：MAD比非POSA更适用于仰卧位或仰卧位为主的习惯性睡眠患者。而对于非仰卧位习惯性睡眠的患者，MAD是非POSA的有效治疗选择。
