The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Hiroyuki Ishiyama; Daichi Hasebe; Kazumichi Sato; Yuki Sakamoto; Akifumi Furuhashi; Eri Komori; Hidemichi Yuasa

doi:10.3390/ijerph16173182

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Int J Environ Res Public Health. 2019 Aug 31;16(17):3182. doi: 10.3390/ijerph16173182.

Authors

Hiroyuki Ishiyama¹, Daichi Hasebe², Kazumichi Sato³, Yuki Sakamoto⁴, Akifumi Furuhashi⁵, Eri Komori⁶, Hidemichi Yuasa⁷

Affiliations

¹ Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo 1138510, Japan. h.ishiyama.rpro@tmd.ac.jp.
² Division of Reconstructive Surgery for Oral and Maxillofacial Region, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, 2-5274 Gakkocho-Dori, Cyuo-ku, Nigata-shi, Nigata 9518514, Japan.
³ Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano Ichikawa-shi, Chiba 2728513, Japan.
⁴ Department of Oral Surgery, Hironokogen Hospital, 3-1-1 Kitayamadai Nishi-ku Kobe-shi, Hyogo 6512215, Japan.
⁵ Department of Oral and Maxillofacial Surgery, Aichi Medical University, 1-1 Yazakokarimata Nagakute-shi, Aichi 4801103, Japan.
⁶ Division of Medicine for Function and Morphology of Sensor Organ, Dentistry and Oral Surgery, Osaka Medical College, 2-7 Daigaku-machi Takatsuki-shi, Osaka 5698686, Japan.
⁷ Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center, 50 Imure-chou Aza Hamamichi-Ue, Toyohashi-shi, Aichi 4408510, Japan.

Abstract

Oral appliance (OA_m) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OA_m therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OA_m versus Bi-block OA_m) remained eligible after applying the exclusion criteria. When comparing Mono-block OA_m and Bi-block OA_m, Mono-block OA_m significantly reduced the apnea-hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OA_m was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO₂, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO₂: -11.18; 95%CI, -26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, -6.00 to 14.80; p = 0.41, non-REM stage 3: -2.00; 95%CI, -6.00 to 14.80; p = 0.41, sleep efficiency: -1.42, 95%CI, -4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, -1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, -0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OA_m was more effective than Bi-block OA_m for OSA patients.

Keywords: bi-block; mono-block; obstructive sleep apnea; oral appliance; systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Arousal
Humans
Orthodontic Appliance Design*
Orthodontic Appliances*
Sleep Apnea, Obstructive / therapy*
Snoring / prevention & control*