Phenotype of Responders to Mandibular Advancement Device Therapy in Obstructive Sleep Apnea Patients: A Systematic Review And Meta-analysis

Objectives: The aim of this systematic review is to synthesize the phenotype of responders and non-responders to mandibluar advancement device (MAD) in osbstructive sleep apnea (OSA) patients at baseline.
Methods: Pubmed, Web of science, Embase, Scopus were searched for eligible studies published until Nov 2018. A total of 644 studies were identified. 29 studies were included in this review, 7 studies were included in the meta-analysis. The quality of the studies was assessed using the risk of bias assessment tool for non-randomized studies (RoBANS).
Results: Within the limitation of the included studies, the responders to MAD therapy had certain clinical, craniofacial, and polysomnographic (PSG) traits, and Pcrit, Arousal threshold, Loop gain and Muscle responsiveness (PALM) traits. Examples of the craniofacial traits of responders from the Meta-analysis included: a smaller maxilla, a smaller ANB angle, a narrower airway, and a shorter distance between the hyoid bone and gnathion point of the mandible than non-responders.
Conclusions: These results could provide information for clinicians about the phenotype of responders and non-responders to MAD therapy in OSA patients. However, whether these phenotypic traits of responders could be used as predictors with cut-off value in the clinic needs to be addressed in future studies.