Islam Hassan, Iman Radi And Amal Kaddah,

ABSTRACT
Background: The Intolerance Of Patients With Obstructive Sleep Apnea To Continuous Positive Airway Pressure Has Lead To Emergence Of Oral Appliances, The Effectiveness Of Which Is Still Doubtful. Objective: To Compare Between The Mandibular Advancement Device ((MAD) As An Intervention)) And (continuous Positive Air Way Pressure (CPAP) As A Comparator)) In The Treatment Of ((patients With OSA) As A Population) Regarding The Following Outcomes, Which Are Primarily Snoring Index And Secondarily Apnea Hypopnea Index (AHI). Data Sources: The Following Databases Were Searched Electronically; Cochrane Library (CENTRAL), LILACS, And PubMed And Grey Literature With Dates (17-19 March 2016).Hand Searching Of Nine Journals Was Done Electronically With Dates (1-5 March 2016), Study Bibliographies Were Reviewed And Authors Were Contacted. Study Selection: RCTs Comparing The Effect Of CPAP Or MAD On AHI And Snoring Index In Patients With OSA Were Selected By Consensus.

Results: Of 5737 Studies Initially Identified, 12 Were Included In This Review. A Meta-analysis Using Random And Fixed-effect Models To Estimate Pooled Differences Between Each Intervention Was Performed. 12 Studies (7 Of Parallel Design RCTs, 5 Of Crossover RCTs), Comparing Between MAD And CPAP, Were Included In This Review Reporting Results Of 553 Subjects. Seven Studies Of One Outcome (AHI) Were Assigned To Meta-analysis. As A Result Of Different Study Designs And Time, Three Comparisons Were Carried Out; Comparison 1 For Parallel Design After 3 Months Of Treatment, Comparison 2 For Crossover Design After 4 Months And Comparison 3 For Parallel Design After 12 Months. Fixed Effect Model Was Used For Comparison 1 And 2, While Random Effect Model Was Used For Comparison 3.

Conclusions: The Prolonged Use Of MAD (more Than One Year) Is As Effective As CPAP In Reducing The AHI. Quality Of Evidence, However, Is Very Low, Which Might Weaken The Recommendations. Properly Conducted RCTs With Follow Up Periods Longer Than One Year, Reporting Snoring, Apnea Hypopnea Index, Excessive Daytime Sleepiness And Health Quality Of Life Score Outcomes Are Still Needed.