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Title Limited Evidence Exists Regarding Long Term Compliance Of Mandibular Advancement Devices (MAD ) For Adult
Clinical Question In an adult population diagnosed with OSA, what is the projected long term treatment patient compliance with a MAD?
Clinical Bottom Line Efficacy of treatment of OSA with an MAD device relies on lifelong patient compliance unless another treatment modality is pursued. While MADs and other oral devices have been successfully used by many patients for the treatment of OSA, the strength of evidence regarding long term compliance has not been determined. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22400135Balk/2012Review of future research topic prioritiesNarrative Review
Key resultsGiven the poor long term compliance with OSA treatments, patients may cross back and forth between treatment options, complicating analyses of trials. A need exists to establish metrics to measure compliance (e.g., at least 4 hours of use per night for more than 70-80 percent of nights per week), provide objective measures of compliance, and determine total sample size and duration needed for RCT study designs. Future research requires: (1) determining the barriers to, and predictors of, compliance with different treatments, (2) the direct comparison of compliance rates with different interventions, and (3) incorporation of compliance into an overall comparison of effective treatment.
#2) 22075487Marklund/201255 studies Systematic Review
Key resultsStudies predominately rely on subjective self-reporting of compliance. Compliance appears to decrease slightly after time. At one year, anticipate about 25% non-compliance with MADs. Between 2-4 years, roughly 50% still persist with MAD use. Some studies report slightly higher compliance rates at 4 years.
#3) 16437488 & TBDLim/2006 & Lim/200916 studies (n=745); 17 Studies (n-831)Systematic Review
Key resultsTwo authors independently searched the Cochrane Airways Group Specialised Register, extracted data, and assessed trial quality. In the 2009 review, six studies met the inclusion criteria for review. Randomized and controlled trials in adults compared oral devices with a control. Limitations cited for studies included small sample size, under reporting of methods and data, and lack of blinding. This Cochrane Review notes the relative efficacy or oral devices remains unclear in comparison to other available treatment modalities.
Evidence Search BALK, MARKLAND: (("sleep apnea, obstructive"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "obstructive sleep apnea"[All Fields] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "sleep apnea, obstructive"[All Fields]) AND (("mandibular advancement"[MeSH Terms] OR ("mandibular"[All Fields] AND "advancement"[All Fields]) OR "mandibular advancement"[All Fields]) AND ("equipment and supplies"[MeSH Terms] OR ("equipment"[All Fields] AND "supplies"[All Fields]) OR "equipment and supplies"[All Fields] OR "device"[All Fields]))) AND ("review"[Publication Type] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields]) LIM: (("sleep apnea, obstructive"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "obstructive sleep apnea"[All Fields] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "obstructive"[All Fields]) OR "sleep apnea, obstructive"[All Fields]) AND ("randomized controlled trials as topic"[MeSH Terms] OR ("randomized"[All Fields] AND "controlled"[All Fields] AND "trials"[All Fields] AND "topic"[All Fields]) OR "randomized controlled trials as topic"[All Fields])) AND ("orthodontic appliances"[MeSH Terms] OR ("orthodontic"[All Fields] AND "appliances"[All Fields]) OR "orthodontic appliances"[All Fields] OR ("orthodontic"[All Fields] AND "appliance"[All Fields]) OR "orthodontic appliance"[All Fields])
Comments on
The Evidence
Limited evidence exists on the long term patient compliance with MADs to treat OSA. Established metrics and objective measures of patient compliance are lacking. Since most studies rely on patient self-reporting, which may be biased towards over reporting compliance, actual compliance success may be lower than published.
Applicability The results are applicable to adult patients who are unable or unwilling to tolerate CPAP as a non-invasive alternative to treat OSA. The study and results must be considered with caution due to a low level of evidence. Future studies with established designs, metrics, and measures are needed. Availability of compliance monitors that provide established experimental measurement would greatly enhance the determination of the long term patient compliance with MADs.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords non-CPAP, long term, patient compliance, mandibular advancement device, sleep apnea, obstructive
ID# 2337
Date of submission: 02/18/2013spacer
E-mail avongonten@gmail.com
Author Ann Sue von Gonten, DDS
Co-author(s) Hanna Lindskog
Co-author(s) e-mail Lindskog@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Roger Arredondo DDS & Concepcion Barboza DDS (San Antonio, Texas) on 05/14/2013
Our search agrees with the statements made in this CAT. The ERS Handbook of Respiratory Sleep Medicine, by the European Respiratory Society-2012-09-01, By Wilfried de Backer, Anita K. Simonds (Editor), ISBN-13:9781849840213 match the numbers stated by Marklund/2012.

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