Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

airway pressure”. The adopted inclusion criteria
consisted of the evidence of OSA in a
polysomnographic examination and the
randomized clinical trials comparing oral appli-
ance with controls or other treatments in adults.
Review papers, non-randomized trials, and
articles without selected control groups and
uniform diagnostic methods which could provide
basis for diagnosing sleep apnea were excluded.

6 Results

We identified 59 clinical trials articles on the

study subject published from the year 2000.

Based on the inclusion and exclusion criteria

for the studies assessing patients with OSA

above outlined, 15 papers were selected, of

which 10 compared therapeutic efficacy of

MAA with CPAP (Tables 1 and 2) and

Table 1 Apnea-hypopnea index (AHI) after the use of different modes of treatment in obstructive sleep apnea (OSA)
patients in randomized clinical trials

Study Baseline CPAP MAA Placebo

Aarab et al. ( 2011 )

(PSG evaluation)

Oral appliance:

21.4
11.0

CPAP: 20.8
9.9

Δ20.2
8.6ʌ Δ15.0
10.5 –

Barnes et al. ( 2004 )

(PSG evaluation)

21.3
1.3 4.8
0.5*{{ 14.0
1.1*{ 20.3
1.1

Doff et al. ( 2013 )

(PSG evaluation)

Oral appliance: 39
 31

CPAP: 40
 28

0 (0–1){(1-yr follow-up)

0 (0–1)#(2-yr follow-up)

2 (0–5)ns

(1-yr follow-up)

2 (1–8)#(2-yr follow-up)

Engelman et.al

(2002)

(home sleep study)

Oral appliance: 30
 21

CPAP: 32
 29

8 
 6 ʌ 15 
 16 –

Hoekema

et al. (2008)

(PSG evaluation)

Oral appliance:

39.4
30.8

CPAP: 40.3
27.6

7.8
14.4β 2.4
4.2β –

Gagnadoux

et al. (2009)

(home sleep study)

34 
 13 2 (1–8)* 6 (3–14)* –

Lam et al. ( 2007 )

(PSG evaluation)

Oral appliance:

20.9
1.7

CPAP: 23.8
1.9

2.8
1.1* 10.6
1.7* –

Phillips et al. ( 2013 )

(PSG evaluation)

25.6
12.3 4.5
6.6§ 11.1
12.1§ –

Randerath

et al. (2002)

17.5
7.7 3.5
2.9§(1 night)

3.2
2.9§»(6 weeks)

10.5
7.5#(1 night)

13.8
11.1 (6 weeks)

Tan et al. ( 2002 )

(PSG evaluation)

22.2
9.6 3.1
2.8* 8.0
10.9* –

Data are means
SD, values with additives in parenthesis are medians and interquartile ranges;Δdownward
difference between baseline and treatment result, CPAP continuous positive airway pressure, MAA mandibular
advancement appliance
*p<0.001vs. baseline
{p<0.001vs. placebo
{p<0.05vs.MAA
§p<0.01vs.baseline
#p<0.05vs. baseline
»p<0.01vs.MAA
βp<0.006vs. baseline
Δp<0.001vs.MAA
nsnon-significant

66 J. Kostrzewa-Janicka et al.