Effectiveness of mandibular advancement devices in obstructive sleep apnea therapy for East Asian patients: a systematic review and meta-analysis.

Abstract

Prior studies have shown that a mandibular advancement device (MAD) is an effective nonsurgical treatment for obstructive sleep apnea (OSA). Most studies were performed in primarily White populations. However, East Asians have restrictive craniofacial features, such as a reduced cranial base, maxilla, and retropalatal space, which may affect their response to treatment. The objective of this study was to systematically review the use of MAD in East Asian patients and determine the effectiveness of MAD in this population. The PubMed, Embase, Scopus, CINAHL, Web of Science, and Cochrane Library databases were searched up to January 15, 2024. Studies that investigated the effects of MAD on the apnea-hypopnea index (AHI), oxygen saturation, blood pressure, and Epworth sleepiness scale (ESS) score, specifically for East Asian patients, were included. PRISMA guidelines were followed for data extraction. Twelve studies with 382 patients were included. The pooled mean reduction in AHI was 19.1 (95% CI -23.9;-14.3,I² = 91%). The improvements in the minimal and mean oxygen saturation were 6.0% (95% CI 4.4, 7.5,I² = 28%) and 1.2% (95% CI -0.2;2.6),I² = 92%), respectively. Oxygen Desaturation Index was also reduced by 13.6 (3 studies, 95% CI 23.9;-3.3,I² = 92%). Systolic and diastolic pressure changes were modest at -4.4 (9% CI -11.3;2.4,I² = 88%) and -3.3 (95% CI = -6.3;-0.3,I² = 55%), respectively. ESS Score had a reduction of 2.0 (95% CI= -3.3;-0.7,I² =66%). MAD is an effective device for the management of East Asian patients with OSA. Although treatment success is expected in most patients, complete resolution is unlikely. (253 words).