This study aims to review the long-term subjective and objective efficacy of mandibular advancement devices (MAD) in the treatment of adult obstructive sleep apnea (OSA). Electronic databases such as PubMed, Embase, and Cochrane Library were searched. Randomized controlled trials (RCTs) and non-randomized self-controlled trials with a treatment duration of at least 1 year with MAD were included. The quality assessment and data extraction of the included studies were conducted in the meta-analysis. A total of 22 studies were included in this study, of which 20 (546 patients) were included in the meta-analysis. All the studies had some shortcomings, such as small sample sizes, unbalanced sex, and high dropout rates. The results suggested that long-term treatment of MAD can significantly reduce the Epworth sleepiness scale (ESS) by -3.99 (95%CI -5.93 to -2.04, p<0.0001, I2 = 84%), and the apnea-hypopnea index (AHI) -16.77 (95%CI -20.80 to -12.74) events/h (p<0.00001, I2 = 97%). The efficacy remained statistically different in the severity (AHI<30 or >30 events/h) and treatment duration (duration <5y or >5y) subgroups. Long-term use of MAD could also significantly decrease blood pressure and improve the score of functional outcomes of sleep questionnaire (FOSQ). Moderate evidence suggested that the subjective and objective effect of MAD on adult OSA has long-term stability. Limited evidence suggests long-term use of MAD might improve comorbidities and healthcare. In clinical practice, regular follow-up is recommended. 

Long-term efficacy of mandibular advancement devices in the treatment of adult obstructive sleep apnea: A systematic review and meta-analysis

Solriamfetol enhances wakefulness and improves cognition and anxiety in a murine model of OSA.

Mandibular advancement splint (MAS) therapy emerged as an effective therapy for obstructive sleep apnoea (OSA) in the mid 1990s, and is now the leading treatment alternative for OSA. Since its inception, the field has seen a suite of revisions and advances in relation to design and customisation, fabrication, titration methods, response prediction models and the integration of data collection technology. This paper reviews these current and emerging innovations in MAS therapy and their impact upon sleep apnoea management.

Innovations in mandibular advancement splint therapy for obstructive sleep apnoea

Abstract Background Obstructive sleep apnea (OSA) is a complex disorder characterized by interruptions in breathing during sleep, leading to a range of adverse outcomes from reduced quality of life to serious health risks, including cardiovascular diseases and increased mortality. Main Body This manuscript reviews the orthodontists’ essential role in the multidisciplinary healthcare team tasked with managing OSA. It particularly highlights critical orthodontic interventions, such as surgical-orthodontic maxillomandibular advancement (MMA), mandibular advancement appliances (MAAs), and rapid maxillary expansion (RME). These interventions are pivotal in modifying craniofacial structures to enhance airway patency. The importance of conducting a thorough airway analysis is underscored, assessing the complete anatomical and functional factors contributing to airway obstruction. Conclusion The paper calls for increased collaborative research efforts to develop standardized, evidence-based orthodontic procedures for effectively managing OSA, aiming to improve patient outcomes through specialized, tailored interventions. 

The role of orthodontists in the multidisciplinary management of obstructive sleep apnea

Abstract Background Neuroplasticity induced by mandibular advancement appliance (MAD) in patients with obstructive sleep apnoea (OSA) is poorly documented. Objective This randomised placebo‐controlled crossover mechanistic study assessed the effects of short‐term use of a MAD on corticomotor excitability of the masseter and tongue in patients with OSA. Methods Adults ( n = 28) with mild or moderate OSA were randomly allocated to sleep with a MAD for 2‐weeks with 40% of the maximal protrusion (MAD active position) and without any jaw protrusion (MAD placebo position). The outcomes were assessed at baseline, and after 2 and 6 weeks, with a 2‐week washout period. The primary outcome was the amplitude of motor evoked potential (MEP) assessed on the right masseter, right side of tongue and right first dorsal interosseous with transcranial magnetic stimulation. Corticomotor map volume of the same muscles was also assessed. Repeated‐measures ANOVAs followed by Tukey test were applied to the data ( p &lt; .050). Results There was a significant increase in the MEP amplitude of the masseter and tongue following the MAD active position compared with the baseline and MAD placebo (Tukey: p &lt; .001). There were no significant MEP amplitude differences between the baseline and placebo positions ( p &gt; .050). Moreover, there was a significant increase in corticomotor map volume for the masseter and tongue muscles following the MAD active position compared with baseline and MAD placebo (Tukey: p &lt; .003). Conclusion Excitability of the masseter and tongue motor pathways is, at least transiently, increased in patients with OSA following a short‐term use of MAD. This novel finding of MAD‐induced neuroplasticity in corticomotor pathways may contribute to a further understanding of the mechanisms of oral appliances for treating OSA. 

Impact of a mandibular advancement device on corticomotor plasticity in patients with obstructive sleep apnea

Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA

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Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA