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. Author manuscript; available in PMC: 2024 Jan 1.
Published in final edited form as: Int Forum Allergy Rhinol. 2023 Mar 30;13(7):1061–1482. doi: 10.1002/alr.23079

TABLE VIII.C.2.

Summary of evidence for mandibular repositioning devices

Study Year LOE (1a–5) Study design Study groups Clinical end-point Conclusion
Araie et al.1382 2018 1a Systematic review and meta-analysis MRD 12 Studies (489 subjects) Cephalometry, dental casts Long-term use associated with dental changes
Bratton et al.1380 2015a 1a Network meta-analysis 1. MRD
2. Control
3 studies (271 subjects)		 Epworth Sleepiness Score MRD reduces daytime sleepiness (ESS) compared to inactive control
Bratton et al.1208 2015b 1a Network meta-analysis 1) MRD 2)Control
3 studies (229 subjects)		 Blood pressure MRD reduce blood pressure compared to inactive control device
Chen et al.1383 2020 1a Systematic review and meta-analysis MRD
41 Studies (1854 subjects)		 1. Age
2. Gender
3. BMI
4. Neck circumference
5. Cephalometry
6. AHI		 On average MRD “responders” are younger, female, less obese, with lower baseline AHI
Johal et al.1371 2017 1a Systematic review and meta-analysis 1. Customized MRD
2. Prefabricated MRD
3 studies (129 subjects)		 1. AHI
2. Proportion treatment responders		 Customized devices have definable advantages including greater efficacy and patient preference and adherence
Kuhn et al.1381 2017 1a Systematic review and meta-analysis 1. MRD
2. Inactive control
3 studies (177 subjects)		 SF-36 (mental and physical components) MRD was associated with improvement in both physical and mental component scores, but only two studies
Lim et al.1379 2006 1a Cochrane systematic review and meta-analysis 1. MRD
2. Inactive control
13 Studies (553 subjects)		 1. AHI
2. LSAT
3. Arousal index		 MRD reduce polysomnographic indices of OSA versus inactive control devices
Ramar et al.809 2015 1a Clinical practice guideline 1. Pre- and post-MRD
2. MRD versus sham-MRD
3. MRD versus CPAP
42 Studies (1307 subjects)		 1. AHI
2. LSAT
3. ODI
4. Arousal index
5. REM%
6. Sleep efficiency		 It is recommended that MRD is prescribed for adult OSA patients, rather than no therapy, who are intolerant of CPAP or prefer alternate therapy

Abbreviations: AHI, apnea hyponea index; BMI, body mass index; CPAP, continuous positive airway pressure; ESS, Epworth Sleepiness Score; LSAT, lowest oxygen saturation; MRD, mandibular repositioning device; ODI, oxygen desaturation index; OSA, obstructive sleep apnea; %REM, percent of total sleep time spent in rapid eye movement sleep stage; SF-36, 36-Item Short Form.