Table 1. Characteristics of the included studies.
| Study | Study design | Treat-ment | Original sample (n) | Dropout (n, %) | Analyzed n (%) | M/F | Diagnosis | Age (y) | BMI (kg/m2) | Severity | Treatment duration | MAD design | Wearing time | Clinical examinations |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Wilhelmsson et al., 1999 [27] | RCT* | MAD vs. UPPP | 49 | 12 (24%) | 37 (76%) | 37/0 | OSA | 49.3 (46.8 to 51.9) | 26.9 (25.6 to 28.3) | AHI 18.2±7.92# | 1y | 50% MMP, 5mm vertical opening | 6.2 nights/week | HSAT |
| Marklund et al., 2001 [39] | Prospective | MAD | 33 | 14 (42%) | 19 (58%) | 17/2 | OSA | 50±12 | 26±3.5 | AHI 22±17 | 5.2±0.4y | 5.3±1.4mm protrusion, 10±1.4mm vertical opening | 50 to 90% nights/week | PSG; questionnaire |
| Rose et al., 2002 [40] | Retrospective | Activator | 86 | 60 (70%) | 26 (30%) | 24/2 | OSA | 55.2±8.2 | 27.8±3.6 | AHI 17.8±8.5 | 1.5 to 2y | 1/2 to 3/4 the width of a premolar protrusion, 8 to 10mm vertical opening | >5h/night, daily | PSG; questionnaire |
| Fransson et al., 2003 [41] | Prospective | MAD | 50 | 6 (12%) | 44 (88%) | 38/6 | OSA | 56 (range 31 to 73) | 30 (range 21 to 38) | ODI 14.7±12.7 | 2y | - | 85% of the patients used every night | PSG; questionnaire |
| Tegelberg et al., 2003 [28] | RCT* | MAD | 74 | 19 (26%) | 55 (74%) | 55/0 | OSA | 50% 51.8(49.0 to 54.6); 75% 54.4(52.4 to 56.4) | 50% 27.4(26.4 to 28.4); 75% 27.9(26.6 to 29.3) | AHI 17.5±4.1 | 1y | 50%/75% MMP, 2mm vertical opening | - | HSAT; questionnaire |
| Itzhaki et al., 2007 [42] | Prospective | Herbst | 19 | 3 (16%) | 16 (84%) | 11/5 | OSA | 54.0±8.3 | 28.0±3.1 | ODI 5.9±9.9 | 1y | 75% MMP | - | PSG; HSAT; questionnaire |
| Ghazal et al., 2009 [29] | RCT* | MAD | 103 | 58 (56%) | 45 (44%) | 36/9 | OSA | 50.4±10.9# | 26.0±2.8# | AHI 34.5±7.5# | 2y | 83% MMP (5.5±2.7mm) | >5 nights/week | PSG; questionnaire |
| Aarab et al., 2011 [30] | RCT* | MAD vs. CPAP | 21 | 6 (29%) | 15 (71%) | - | OSA | 50.4±8.9 | 27.1±3.1 | AHI 21.4±11.0 | 1y | 25% MMP(n = 1), 50% MMP(n = 7), 75% MMP (n = 12) | - | PSG; questionnaire |
| Gauthier et al., 2011 [34] | RCT* | MAD | 16 | 2 (13%) | 14 (87%) | 10/4 | OSA | 51.9±1.7 | - | RDI 10.4±1.3 | Range 2.5 to 4.5 y | 81% to 96% MMP, 6.5 to 8.5mm vertical opening | 7.1 h/night, 6.4 nights/week | PSG; questionnaire |
| Doff et al., 2013 [35] | RCT* | MAD vs. CPAP | 51 | 22 (43%) | 29 (57%) | - | OSA | 49±10 | 32±6 | AHI 39±31 | 2.3±0.2 y | 50% MMP | 7.2±0.8 h/night; 6.7±0.7 nights/week | PSG; questionnaire |
| Gong et al., 2013 [43] | Retrospective | MAD | 412 | 318 (77%) | 94 (23%) | - | OSA | - | - | AHI 27.08±25.31# | 74 (30 to 99)m | 60 to 70% MMP, 4 to 5mm vertical opening | 6 to 8h/night, 5 to 7 nights/week | PSG; questionnaire; lateral cephalogram |
| Eriksson et al., 2014 [36] | Prospective | MAD | 77 | 32 (42%) | 45 (58%) | 35/10 | OSA or snoring | 54.0±8.0# | 29.3±3.8# | ODI 9.4±12.3# | 10y | - | - | PSG; questionnaire |
| Ballanti et al., 2015 [44] | Prospective | MAD | 35 | 7 (20%) | 28 (80%) | 22/6 | OSA | 52.2±6.8 | 25.8±1.7 | AHI 12.4±3.6 | 2y | 75% MMP, 6mm vertical opening | - | PSG; questionnaire |
| Marklund et al., 2016 [37] | Prospective | MAD | 630 | 621 (99%) | 9 (1%) | 8/1 | OSA | 51.7 (41.7, 59.1) | 26.5 (24.7, 31.1) | AHI 17.3 (9.7, 26.5) | 16.5 (16.3, 18.0) y | 6.0(5.0, 7.5)mm protrusion | - | PSG |
| de Godoy et al., 2017 [38] | RCT | MAD vs. placebo | 36 | 6 (17%) | 30 (83%) | 21/9 | UARS | 43.7±7.7 | 26.6±4.1 | - | 1.5y | 50% MMP | 6.3±1.8h/night, 77% nights/week | PSG; questionnaire |
| Gupta et al., 2017 [45] | Prospective | MAD | 30 | 0 (0%) | 30 (100%) | 25/5 | OSA | 41±4 | 22±5 | AHI 22 (5 to 30) | 2y | 70% MMP | - | PSG; blood pressure |
| Knappe et al., 2017 [46] | Prospective | MAD | 43 | 29 (67%) | 14 (33%) | - | OSA | 54 | - | AHI 20.5(7 to 57) | 3y | 77.2% MMP | - | PSG; intraoral examinations |
| Vigié du Cayla et al., 2019 [47] | Prospective | Somnodent®, ORM® | 24 | 0 (0%) | 24 (100%) | 15/9 | OSA | 54.3±12.6 | 27.2±5.7 | AHI 35.5±18.2 | 3.9±2.4y | 6.8(5 to 9) mm protrusion | - | PSG; questionnaire; lateral ceohalogram |
| Uniken Venema et al., 2020 [31] | RCT* | Thornton Adjustable Positioner | 51 | 37 (73%) | 14 (27%) | 12/2 | OSA | 61±8 | 32.4±6.6 | AHI 31.7±20.6 | 10.0±0.6y | 50%MMP | 7.8±0.9h/night, 6.6±1.0nights/week | PSG; questionnaire |
| Baldini et al., 2022 [48] | Retrospective | AMO®, SomnoDent® | 444 | 327 (74%) | 117 (36%) | 81/36 | OSA | 62.0 (54.0, 69.0) | 26.0 (24.0, 28.0) | ODI 16.0(8.0, 27.0) | 4.6 (2.6, 6.6)y | 88.9(77.8, 100.0)% MMP | 7 h/night, 7 nights/week | HSAT; lateral cephalogram; questionnaire |
| Lai et al., 2022 [32] | RCT* | MAD vs. CPAP | 52 | 5 (10%) | 47 (90%) | 44/3 | Severe OSA | 46.72±10.19 | 29.33±2.53# | AHI 33.55±6.52# | 1y | 4.5mm protrusion | Approximately 6 h/night, 5 nights/week | PSG; questionnaire; lateral cephalogram |
| Luz et al., 2023 [33] | RCT* | MAD vs. CPAP vs. control | 25 | 6 (24%) | 19 (76%) | - | OSA | 44.8±15.1 | 28.2±7.2 | AHI 9.3±5.2 | 1y | The maximum comfortable protrusion | - | PSG; questionnaire |
*Randomized controlled trial (RCT) in a short-term period
# Calculated from the results of the study
BMI: body mass index; MAD: mandibular advancement device; UPPP: uvulopalatopharyngoplasty; OSA: obstructive sleep apnea; AHI: apnea-hypopnea index; MMP: maximal mandibular protrusion; HSAT: home sleep apnea test; PSG: polysomnography; ODI: oxygen desaturation index; ODI: oxygen desaturation index; CPAP: continuous positive airway pressure; UARS: upper airway resistance syndrome.