Mandibular Advancement Device Effects on the Upper Airway Anatomy and Function: An Umbrella Review
Bibliographic record
Abstract
Study Objectives:To summarize systematic reviews regarding function and anatomy of the upper airway and subjective evaluations on breathing capability depending on the advancement and/or opening of the mandible.Methods: Four databases were searched based on inclusion criteria.Two independent reviewers evaluated abstracts of all articles for phase 1 and full text in phase 2 of selection.The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was used as a guideline; weaknesses were assessed using the AMSTAR2 tool.Results: Twelve systematic reviews were included.Mandibular protrusion greater than 50% of maximum protrusion results in a decrease of apnea-hypopnea index (AHI) by an average of 62.3% and an increase in oxygen saturation (SaO2).These findings correlate with dimensional changes in the upper airway, tongue, soft palate, and hyoid positions.Changes in the nasopharynx are minimal; however, significant volumetric increase of the oropharynx after mandibular advancement device (MAD) use in growing patients was observed.Improved Epworth Sleepiness Scale scores were reported for all included studies in one review.All MAD designs reviewed in the study show the potential to reduce AHI and respiratory disturbance index, with slightly lower AHI levels with those devices favoring more anterior than vertical mandibular movement.Conclusion: Devices that favor progressive mandibular advancement with less vertical opening have the potential to decrease AHI and increase SaO2.Findings of this review can help clinicians determine titration amounts of mandibular advancement for specific patients and can help gauge the level of MAD efficacy on patients with sleep apnea. Statement of Significance:Approximately 80 million Americans have sleep disordered breathing (SDB); 1 of 5 have mild to moderate obstructive sleep apnea (OSA), and 1 of 15 have moderate to severe OSA.Part of the population in whom SDB/OSA has been diagnosed for any reason cannot use continuous positive airway pressure (CPAP).The alternate treatment is the mandibular advancement device (MAD).The MAD's function is to protrude and help stabilize the mandible to maintain a patent upper airway during sleep.MAD accounts for approximately 5% of the total OSA therapy in the United States, and some patients have indications to use MAD rather than CPAP.Therefore, it is of utmost importance to summarize the literature about MAD use and its effects on the respiratory capability of patients in whom SDB is diagnosed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.032 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.008 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".