阻塞性睡眠呼吸暂停
医学
持续气道正压
斯科普斯
科学网
梅德林
叙述性评论
纳入和排除标准
多导睡眠图
多学科方法
重症监护医学
口腔矫治器
医学诊断
睡眠呼吸暂停
替代医学
呼吸暂停
病理
荟萃分析
内科学
社会科学
社会学
政治学
法学
作者
Antonino Lo Giudice,Salvatore La Rosa,G Palazzo,Carole A. Federico
出处
期刊:Diagnostics
[MDPI AG]
日期:2024-08-30
卷期号:14 (17): 1915-1915
标识
DOI:10.3390/diagnostics14171915
摘要
Background: Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA. Methods: An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs. Results: The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics. Conclusions: Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient’s clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient’s adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD.
科研通智能强力驱动
Strongly Powered by AbleSci AI