Effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in Treating Patients with Mild to Moderate Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Nian ¹ , TU Xueping ¹ ,  HU Ke ¹ , XIAO Jinxiu ¹ , GUO Yi ²

1. Department of Respiratory, Renmin Hospital of Wuhan University, Wuhan 430060, China;2. Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China;

Corresponding author：

HU Ke, Email: huke-rmhospital@163.com

Keywords：

Oral appliance; Continuous positive airway pressure; Obstructive sleep apnea-hypopnea syndrome; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130039

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS).
Methods 　The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using RevMan 5.1 software. Besides, the level of evidence was graded using GRADEpro 3.6 software.
Results 　A total of 7 RCTs were included. The results of meta-analysis showed that: a) compared with OA, CPAP significantly reduced the degree of apnea-hypopnea index (AHI) (WMD=9.13, 95%CI 8.77 to 9.50, P lt;0.000 01); and b) there was no significant difference in the Epworth sleeping scale (ESS) between OA and CPAP (WMD=0.00, 95%CI −0.12 to 0.12, P=0.97).
Conclusion 　Compared with OA, CPAP takes remarkable effects in improving AHI for mild to moderate OSAHS, but it shows no significant difference in improving ESS. For the quality and quantity limitation of the included studies, this conclusion still needs to be proved by conducting more high quality RCTs.

Citation： WANG Nian,TU Xueping,HU Ke,XIAO Jinxiu,GUO Yi. Effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in Treating Patients with Mild to Moderate Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(2): 231-235. doi: 10.7507/1672-2531.20130039 Copy

1.	中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 2002, 25(4): 195-198.
2.	Lim J, Lasserson T J, Fleetham J, et al. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev, 2004, (4): D4435.
3.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
4.	Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 2004, 328(7454): 1490.
5.	Ferguson KA, Ono T, Lowe AA, et al. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996, 109(5): 1269-1275.
6.	Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax, 1997, 52(4): 362-368.
7.	Randerath WJ, Heise M, Hinz R, et al. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 2002, 122(2): 569-575.
8.	Tan YK, L’Estrange PR, Luo YM, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod, 2002, 24(3): 239-249.
9.	Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10.	Aarab G, Lobbezoo F, Heymans MW, et al. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration, 2011, 82(2): 162-168.
11.	Aarab G, Lobbezoo F, Hamburger HL, et al. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration, 2011, 81(5): 411-419.
12.	Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, 3: D1106.
13.	叶红, 李涛平, 冯媛, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者疗效的系统评价. 中国循证医学杂志, 2009, 9(10): 1067-1073.
14.	Marshall NS, Barnes M, Travier N, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax, 2006, 61(5): 430-434.
15.	章志丹, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, 35(3): 324.

1. 中华医学会呼吸病学分会睡眠呼吸疾病学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(草案). 中华结核和呼吸杂志, 2002, 25(4): 195-198.
2. Lim J, Lasserson T J, Fleetham J, et al. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev, 2004, (4): D4435.
3. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011].The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
4. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ (Clinical research ed.), 2004, 328(7454): 1490.
5. Ferguson KA, Ono T, Lowe AA, et al. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest, 1996, 109(5): 1269-1275.
6. Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax, 1997, 52(4): 362-368.
7. Randerath WJ, Heise M, Hinz R, et al. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 2002, 122(2): 569-575.
8. Tan YK, L’Estrange PR, Luo YM, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod, 2002, 24(3): 239-249.
9. Barnes M, Mcevoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med, 2004, 170(6): 656-664.
10. Aarab G, Lobbezoo F, Heymans MW, et al. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration, 2011, 82(2): 162-168.
11. Aarab G, Lobbezoo F, Hamburger HL, et al. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration, 2011, 81(5): 411-419.
12. Giles TL, Lasserson TJ, Smith BH, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev, 2006, 3: D1106.
13. 叶红, 李涛平, 冯媛, 等. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者疗效的系统评价. 中国循证医学杂志, 2009, 9(10): 1067-1073.
14. Marshall NS, Barnes M, Travier N, et al. Continuous positive airway pressure reduces daytime sleepiness in mild to moderate obstructive sleep apnoea: a meta-analysis. Thorax, 2006, 61(5): 430-434.
15. 章志丹, 黄席珍. Epworth嗜睡评价量表与多次小睡潜伏时间试验在评价白天嗜睡的相关性研究. 中国医科大学学报, 2006, 35(3): 324.

Chinese Journal of Evidence-Based Medicine

Effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in Treating Patients with Mild to Moderate Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis

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