Mandibular Advancement Devices for Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis aimed to evaluate the effectiveness of mandibular advancement devices (MADs) in treating Obstructive Sleep Apnea (OSA), focusing on the impact of age and body mass index (BMI) on the apnea-hypopnea index (AHI) and minimum oxygen saturation (min SpO2). Methods: A literature search was conducted in PubMed and Google Scholar for studies published from January 2013 to January 2023. Two independent authors screened the studies, assessed and evaluated risk of bias. Disagreements were resolved by consensus or consultation with a third reviewer and senior experts. The initial search yielded 1110 references, with 13 selected for inclusion. Results: MADs significantly reduced AHI and increased min SpO2 in OSA patients. The mean difference in AHI was 15.75 (95% CI 13.19-18.30, p ⟨0.00001). Minimum SpO2 improved post-treatment (-3.70, 95% CI-5.52 to-1.88, p ⟨ 0.00001, Z = 3.98). Conclusion: This meta-analysis demonstrated that MADs effectively reduced AHI severity and increased min SpO2 in OSA patients. While BMI had no significant effect, age had a notable impact on treatment outcomes.