Table 1.
Characteristics and principal outcomes of the included studies.
| Sr. No. | Study | Study Design | Participants & Settings | Exposure (Patient or Disease Characteristics, Type of Appliance, Psychological or Social Factor) |
Outcome (Increased/Decreased or No effect on Adherence) |
Appliance | Measurement of Adherence | Intervention for Adherence |
|---|---|---|---|---|---|---|---|---|
| 1 | Clark et al, 200057 | Retrospective observational study | Orofacial Pain & Oral medicine, University of California (n = 53, M/F: 46/7, Mean age: 55.7 y, Mean AHI < 30 events/h) | Side effects | Decreased adherence | Herbst Appliance | Self-reported | Nil |
| 2 | McGown et al, 200152 | Retrospective observational study | Middlesex Hospital, RNTNE Hospital, RLH (n = 126, Mean AHI < 30 events/h) | Patient Characteristics | No association with adherence | Modified Adjustable Silensor and Herbst Device | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| Psychological (Self-perceived changes) and Social factors | Increased adherence | |||||||
| 3 | Rose et al, 200253 | Retrospective observational study | Respiratory Care, University Hospital of Frieburg, Germany (n = 188, M/F: 168/23, Mean age: 54.4 y) | Patient & Disease Characteristics | No association with adherence | Custom-made OA (Esmarch IPG) | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| Psychological (Self-perceived Changes) | Decreased adherence | |||||||
| 4 | De Almeida et al, 200526 | Retrospective observational study | University of British Columbia, Canada (n = 544, M/F: 202/49, Mean age: 49.9 y, Mean AHI: 30.25 events/h) | Patient & Disease characteristics | No association with adherence | Oral Appliance | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| Social factors (Bed partners satisfaction)* | Increased adherence | |||||||
| 5 | Izci et al, 200551 | Retrospective observational study | Department of Sleep Medicine, Edinburgh University (n = 144, M/F: 114/30, Mean age: 51 y, Mean AHI: 24 events/h) | Patient characteristics | No association with adherence | Mandibular Repositioning Splint | Self-reported | Nil |
| Psychological factors (Marital Satisfaction)** | Increased adherence | |||||||
| Side effects | Decreased adherence | |||||||
| 6 | Bates et al, 200656 | Prospective observational study | Department of Orthodontics, Victoria Hospital (n = 121, M/F: 83/38, Mean age: 49.55 y, Mean AHI: 18.21 events/h) | Side effects | Decreased adherence | Mandibular Repositioning Splint | Self-reported | Nil |
| 7 | Vanderveken et al, 200841 | Randomized Control trial | University of Antwerp, Belgium (n = 35, M/F: 29/6, Mean age: 49 y, Mean AHI: 14 events/h) | Appliance fabrication and titration procedure (Ready-made OA vs Custom-made OA) | Increased adherence with Custom-made OA | Ready-made OA (SnoreGuard Plus) and Custom-made OA | Self-reported | Nil |
| 8 | Ghazal et al, 200920 | Randomized Control trial | Respiratory Care, University Hospital of Freinburg, Germany (n = 103, M/F: 48/55, Mean age: 50.5 y, Mean AHI: 34.5 events/h) | Patient & Disease characteristics | No association with adherence | IST and Thornton Anterior Positioner (TAP) | Self-reported | Nil |
| Appliance Fabrication (IST vs TAP) | Increased adherence with IST | |||||||
| 9 | Tsuda et al, 201049 | Prospective observational study | Kyushu Dental University, Japan (n = 47, M/F: 40/7, Mean age: 53.1 y, Mean AHI: 21.3 events/h) | Patient & Disease Characteristics (BMI and ESS) | Decreased adherence in association with higher ESS and BMI | Boil- Bite Appliance (TheraSnore) | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| 10 | Cunali et al, 201132 | Randomized Control trial | Federal University of Sao Paulo, Brazil (n = 29, M/F: 10/19, Mean age: 48.5 y, Mean AHI: 17 events/h) | Intervention- Support Therapy | Increased adherence | OA (Brazilian Repositioning device BRD) | Self-reported | Support Therapy (Mandibular Exercises) |
| 11 | Brette et al, 201246 | Prospective observational study | Antoine-Beclere & Argenteuil Hospitals (n = 140, M/F: 108/32, Mean age: 62 y, Mean AHI: 27 events/h) | Patient & Disease Characteristics | Decreased adherence | Custom-made adjustable device (OPM4 J device) | Self-reported | Nil |
| Social Support | Decreased adherence | |||||||
| Appliance characteristics | Decreased adherence | |||||||
| 12 | Freidman et al, 201255 | Case series | Advanced Centre for Specialty Care, Chicago (n = 180, M/F: 130/50, Mean age: 61.5 y, Mean AHI: 33.9 events/h) | Side effects | Decreased adherence | Ready-made OA (SomnoGuard AP) and Custom-made OA (Thornton Adjustable Positioner TAP 3) | Self-reported | Nil |
| Appliance Fabrication (Ready-made OA vs Custom-made OA) | Increased adherence with Custom-made OA | |||||||
| 13 | Zhou et al, 201239 | Randomized Control trial | Department of Orthodontics, Tongji University (n = 16, M/F: 13/3, Mean age: 45.23 y, Mean AHI: 38 events/h) | Appliance fabrication and titration procedure (Monobloc OA vs two-piece OA) | Increased adherence with Monobloc OA | Monobloc OA (Activator) and Bibloc OA (Silent Nite) | Self-reported | Nil |
| 14 | Dieltjens et al, 201354 | Case-control study | University of Antwerp, Belgium (n = 82, M/F: 56/26, Mean age: 49.5 y, Mean AHI: 18 events/h) | Psychological factors (Type D personality) | Decreased adherence | Custom-made Mono Bloc OA and Custom-made Bibloc titratable OA (RespiDent Butterfly) | Self-reported | Nil |
| 15 | Ingman et al, 201348 | Retrospective observational study | Department of Oral & Maxillofacial Diseases, Helsinki University Hospital (n = 96, M/F: 68/28, Mean age: 50.5 y, Mean AHI: 18.4 events/h) | Patient characteristics (length of the maxilla, mandible and soft palate, oropharyngeal space, crepitation at TMJ) | Increased adherence with shorter mesio-distal length of the maxilla and mandible, and crepitation at right TMJ | Mandibular Advancement Splint | Self-reported | Nil |
| 16 | Lee at al, 201335 | Nonrandomized control trial | Department of Otorhinolaryngology, Seoul National University (n = 153, M/F: 138/15, Mean age: 51.2 y, Mean AHI: 32.8 events/h) | Appliance fabrication and titration procedure (Monobloc OA vs Bibloc OA) | Increased adherence with Bibloc OA | Monobloc and Bibloc OA | Self-reported | Nil |
| 17 | Quinnell et al, 201437 | Randomized Control trial | Papworth Hospital Sleep Centre, (n = 90, M/F: 72/81, Mean age: 50.9 y, Mean AHI: 13.8 events/h) | Appliance fabrication (Boil- Bite vs Semibespoke vs Be-spoke) | Increased adherence with the Be-spoke oral appliance | Boil-bite OA (Sleep pro 1), Semibespoke OA (Sleep pro 2), and Bespoke OA | Self-reported | Nil |
| 18 | Wang et al, 201438 | Randomized Control trial | Dept. of Otorhinology, Hospital of Anhui Medical University (n = 22, M/F: 22/0, Mean age: 51.9 y, Mean AHI: 48.16 events/h) | Appliance Type (Adjustable OA vs Nonadjustable OA) | Increased adherence with the adjustable OA | Rod Type OA (Erkodent Silensor) and Controllable appliance (Twin Bloc) | Self-reported | Nil |
| 19 | Dieltjens et al, 201533 | Prospective observational study | Antwerp University Hospital, Belgium (n = 51, M/F: 38/13, Mean age: 49.3 y, Mean AHI: 14.9/h, Mean AHI: 18.4 events/h) | Patient (Anthropometric) & Disease characteristics (Polysomnographic measure) | No association with adherence | Custom-made titratable OA (RespiDent Butterfly) | Objective (Theramon Sensors) | Nil |
| Side effects | Decreased adherence | |||||||
| 20 | Prescinotto et al, 201544 | Retrospective observational study | Federal University of Sao Paulo, Brazil (n = 28, M/F: 9/19, Mean age: 48.8 y, Mean AHI; 17.5 events/h) | Patient characteristics (upper airway abnormalities) | No association with adherence | Custom-made OA | Self-reported | Nil |
| 21 | Attali et al, 201622 | Prospective observational study | Pitié-Salpétrière, France (n = 279, M/F: 98/81, Mean age: 58 y, Mean AHI: 26 events/h) | Appliance factors | Decreased adherence | Ready-made OA (Naval Resmed) and Custom-made OA (Somnodent SomnoMed) | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| Psychological factors | Decreased adherence | |||||||
| 22 | Carballo et al, 201642 | Retrospective observational study | Veterans Affairs Medical Centre, Brazil (n = 33, M/F: 32/1, Mean age: 71.4 y) | Psychological and social factors | No association with Adherence | Oral Appliance | Self-reported | Nil |
| 23 | Makihara et al, 201658 | Retrospective observational study | Kyushu Dental University, Japan (n = 48, M/F: 35/13, Mean age: 64.9 y) | Side effects | Decreased adherence | Boil- Bite Appliance (TheraSnore) | Self-reported | Nil |
| Psychological factors | Decreased adherence | |||||||
| 24 | Nerfeldt et al, 201643 | Prospective intervention study | Department of Clinical Science, Karolinska Institute Stockholm, Sweden (n = 66, M/F: 37/35, Mean Age: 48.5 y, Mean AHI: 16 events/h) | Disease Characteristics (Arousers vs Desaturaters) | Increased adherence in arousers | Monobloc titratable OA | Self-reported | Nil |
| 25 | Vecchierini et al, 201650 | Prospective intervention study | Multicenter (n = 369, M/F: 273/96, Mean age: 52.6 y, Mean AHI: 29.5 events/h) | Side effects | Decreased adherence in the early stages of the treatment | Custom-made OA (Narval) | Self-reported | Nil |
| 26 | Al-Dharrab et al, 201736 | Randomized Control trial | Faculty of Dentistry, King Abdul-Aziz University (n = 12, M/F: 2/10, Mean age: 46 y, Mean AHI: 26 events/h) | Appliance fabrication and titration procedure (Titratable vs Nontitratable) | Increased adherence with Titratable appliance | Custom-made titratable OA (Foresta Dent, Bite Jumping screw) and nontitratable OA | Self-reported | Nil |
| 27 | Gagnadoux et al, 201734 | Nonrandomized control trial | University of Angers and Saint-Antoine Hospital, France (n = 158, M/F: 104/54, Mean age: 54 y, Mean AHI: 27.7 events/h) | Appliance fabrication and titration procedure (Ready-made OA vs Custom-made OA) | Increased adherence with Custom-made OA | Ready-made OA (BluePro) and Custom-made OA (Somnodent and Amo Device) | Self-reported | Nil |
| 28 | Haviv et al, 201759 | Mixed-methods | Department of Oral Medicine, Hebrew University (n = 52, M/F: 48/4, Mean age: 56.75 y, Mean AHI ≤ 40 events/h) | Side effects | Decreased adherence | Herbst Device | Self-reported | Nil |
| Psychological factors | Decreased adherence | |||||||
| 29 | Johal et al, 201740 | Randomized Control trial | Royal London Dental Hospital, Queen Mary University of London, (n = 35, M/F: 21/14, Mean age: 44.9 y, Mean AHI: 13.3 events/h) | Appliance fabrication and titration procedure (Ready-made OA vs Custom-made OA) | Increased adherence with Custom-made OA | Ready-made OA (Snoreshield) and Custom-made OA | Self-reported | Nil |
| 30 | Nishigawa et al, 201747 | Retrospective observational study | Department of General Dentistry, Tokushima University Hospital Japan (n = 40, M/F: 28/12, Mean age: 57.8 y) | Side effects | Decreased adherence | Herbst Appliance | Self-reported | Nil |
| Psychological factors | Decreased adherence | |||||||
| 31 | Saglam-Aydinatay et al, 201845 | Retrospective observational study | Department of Orthodontics, Hacettepe University, Ankara, Turkey (n = 69, M/F: 52/17, Mean age: 54.4 y, Mean AHI < 30 events/h) | Patient & Disease Characteristics | No association with adherence | Monobloc OA and Twin-bloc OA | Self-reported | Nil |
| Side effects | Decreased adherence | |||||||
| Psychological (Self-perceived changes) and social factors | Increased adherence |
*Improvement reported by the partner in the patient's snoring. ** Marital quality and bed sharing. AHI = apnea-hypopnea index, BMI = body mass index, F = female, M = male, OA = oral appliance, TAP = Thornton anterior positioner.