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Iftikhar IH, Cistulli PA, Jahrami H, Alamoud KA, Saeed M, Soulimiotis AP, BaHammam AS. Comparative efficacy of mandibular advancement devices in obstructive sleep apnea: a network meta-analysis. Sleep Breath 2023; 27:1365-1381. [PMID: 36374442 DOI: 10.1007/s11325-022-02744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To analyze relative efficacies of mandibular advancement devices (MAD) in sleep apnea treatment. METHODS From eligible randomized controlled trials (RCT), MADs were classified based on their mechanistic designs. Data on apnea-hypopnea index (AHI), Epworth sleepiness scale (ESS), nadir oxygen saturation (minSaO2), and sleep efficiency (SE%) from RCTs were then analyzed in network meta-analyses, and relative ranking of different MADs was computed based on P scores (a method of ranking similar to SUCRA). Similar analyses were conducted based on the different brands of MADs. RESULTS There were no statistically significant differences between MADs in any of the outcomes analyzed. However, the P-scores, based on the point estimates and standard errors of the network estimates, ranked some MADs higher than others in some of the outcomes. Of the different mechanistic designs, the highest P scores were achieved for attached midline traction (P score = 0.84) and unattached bilateral interlocking (P score = 0.78) devices for AHI reduction, attached bilateral traction (P score = 0.78) and unattached bilateral interlocking (P score = 0.76) for ESS, monobloc (P score = 0.91) and unattached bilateral interlocking (P score = 0.64) for minSaO2, and unattached bilateral interlocking (P score = 0.82) and attached bilateral traction (P score = 0.77) for SE%. Notable findings in the network meta-analyses based on MAD brands, of the limited number of studies that specified them were the effects of SomnoDent Flex™, TAP™, and IST® in their effects on AHI reduction, with P scores of 0.94, 0.83, and 0.82, respectively. Monobloc decreased supine-AHI the most (- 44.46 [- 62.55; - 26.36], P score = 0.99), and unattached bilateral interlocking had the greatest effect on REM-AHI (- 11.10 [- 17.10; - 5.10], P score = 0.87). CONCLUSIONS Findings from this study show clinically (but not statistically) significant differences between MADs in terms of their relative efficacy when analyzed for different sleep apnea treatment outcomes and sleep apnea phenotypes.
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Affiliation(s)
- Imran H Iftikhar
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, Atlanta, USA.
- Atlanta Veterans Affairs Medical Center, Atlanta, USA.
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Haitham Jahrami
- Ministry of Health, Manama, Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Khalid A Alamoud
- Department of Preventive Dental Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maarij Saeed
- Dental College, HITEC Institute of Medical Sciences, Rawalpindi, Pakistan
| | - Andrew P Soulimiotis
- Sleep Apnea & Snoring Solutions (Private Practice), North Druid Hills Georgia, Atlanta, USA
| | - Ahmed S BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia (08-MED511-02), Riyadh, Saudi Arabia
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Bortolotti F, Corazza G, Bartolucci ML, Incerti Parenti S, Paganelli C, Alessandri-Bonetti G. Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta-analysis and meta-regression. J Oral Rehabil 2021; 49:553-572. [PMID: 34865235 DOI: 10.1111/joor.13290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking. OBJECTIVES The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom-made (CM) and non-custom-made (NCM) MAD therapies. SEARCH METHODS An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included. DATA COLLECTION AND ANALYSIS The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study. RESULTS Thirty-two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta-analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128-0.213] with a mean follow-up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033-6.803]) compared to NCM MADs (5.107 [4.324-5.890]. The meta-regression showed that the dropout rate increases significantly during time (p < .05). CONCLUSIONS There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD. REGISTRATION The study protocol was registered on PROSPERO (n. CRD42020199866).
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Affiliation(s)
- Francesco Bortolotti
- Section of Orthodontics, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Corazza
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
| | - Maria Lavinia Bartolucci
- Section of Orthodontics, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Serena Incerti Parenti
- Section of Orthodontics, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Corrado Paganelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy
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Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review. Int J Dent 2021; 2021:6676158. [PMID: 34035815 PMCID: PMC8124002 DOI: 10.1155/2021/6676158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Recent clinical guidelines have extended indications for oral appliances to subjects affected by moderate-to-severe obstructive sleep apnoea (OSA). The aim of this systematic review covering this important issue for public health is twofold: updating and summarizing the best available scientific evidence by selecting RCTs of quality only, and identifying the therapeutic pathways that can be transferred to the current clinical practice. Methods All the abstracts which were published before February 18, 2019, have been identified in three electronic databases (PubMed, Web of Science, and Cochrane). The Cochrane Collaboration's tool for assessing risk of bias was used as an assessment tool in order to evaluate the quality of the selected studies. Results The search strategy yielded 2,260 studies. After removing duplicates and studies that did not comply with the inclusion criteria, 32 full-text articles were assessed for eligibility, and 17 RCTs were finally included in the qualitative synthesis. The 17 selected studies were very heterogeneous in the type of included RCTs in terms of patient inclusion criteria, sample size, distribution of the two genders in the various groups, duration of treatment, and definition of primary and secondary outcomes, without any restriction on the definition of the control group. A common finding was the positive responsiveness of oral appliance treatment in subjects affected by mild-to-moderate OSA with some evidence for cases of severe OSA. Conclusion Higher-quality studies are needed in order to provide additional useful guidelines for dental clinicians for OSA management.
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De Meyer MMD, Vanderveken OM, De Weerdt S, Marks LAM, Cárcamo BA, Chavez AM, Matamoros FA, Jacquet W. Use of mandibular advancement devices for the treatment of primary snoring with or without obstructive sleep apnea (OSA): A systematic review. Sleep Med Rev 2020; 56:101407. [PMID: 33326914 DOI: 10.1016/j.smrv.2020.101407] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023]
Abstract
The aim of this review was to systematically evaluate the available scientific evidence on the benefit of mandibular advancement devices (MADs) in the treatment of primary snoring (PS). From 905 initially identified articles, 18 were selected. Papers that provided indirect information regarding obstructive sleep apnea syndrome (OSAS) and/or sleep breathing disorders (SBD) were included. Information was obtained on monoblock and duoblock appliances from the selected studies. The devices were most commonly able to achieve 50%-70% of the maximum mandibular protrusion. The frequently used outcome measurements were the apnea-hypopnea index, Epworth sleepiness scale, and oxygen desaturation index, which all yielded positive post-treatment results. The most common side effects were temporomandibular joint pain and excessive salivation, which improved with time. Our findings indicated that the use of MADs, even with varying designs, improved outcomes in all the reported patient populations (PS, OSAS, and SBD). Despite the lack of studies on PS, the available evidence supports the use of MADs for treatment of PS. Snoring should be treated from a preventive and psychosocial perspective to avoid progression to more severe diseases that could have a significant medical and economic impact.
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Affiliation(s)
- Micheline M D De Meyer
- Oral Health in Special Needs, Sleep Breathing Disorders, Oral Health Sciences, Ghent University Hospital, Gent, Belgium; Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Pneumology, UZ Brussels, Brussels, Belgium; Faculty of Dentistry, University of Concepción, Concepción, Chile; Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium; Department of Materials, Textiles and Chemical Engineering, Faculty of Engineering and Architecture, Ghent University, Belgium.
| | - Olivier M Vanderveken
- Department of Ear, Nose, and Throat, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Luc A M Marks
- Special Care in Dentistry, Oral Health Sciences, Ghent University Hospital, Gent, Belgium
| | | | - Andrés M Chavez
- Faculty of Dentistry, University of Concepción, Concepción, Chile
| | | | - Wolfgang Jacquet
- Special Care in Dentistry, Oral Health Sciences, Ghent University Hospital, Gent, Belgium; Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium; Department of Materials, Textiles and Chemical Engineering, Faculty of Engineering and Architecture, Ghent University, Belgium
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Hofauer B, Braumann B, Heiser C, Herzog M, Maurer JT, Plößl S, Sommer JU, Steffen A, Verse T, Stuck BA. Diagnosis and treatment of isolated snoring-open questions and areas for future research. Sleep Breath 2020; 25:1011-1017. [PMID: 32623557 PMCID: PMC8195801 DOI: 10.1007/s11325-020-02138-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVES Snoring is a common phenomenon which is generated by vibration of soft tissue of the upper airway during sleep. Due to the high incidence of isolated snoring and the substantial burden for the patient and the bed partner, a thorough examination and appropriate therapy are required. Many recommendations for the treatment of isolated snoring are either not evidence-based or are derived from recommendations for the management of obstructive sleep apnea. Therefore, the aim of this study is the identification and description of open questions in the diagnosis and treatment of isolated snoring and the illustration of areas for further research. METHODS In the context of the development of the new version of the German guideline "Diagnosis and treatment of isolated snoring in adults," a multidisciplinary team of experts performed a systematic literature search on the relevant medical data and rated the current evidence regarding the key diagnostic and therapeutic measures for snoring. RESULTS The systematic literature review identified 2293 articles. As a major inclusion criterion, only studies on primary snoring based on objective sleep medical assessment were selected. After screening and evaluation, 33 full-text articles remained for further analysis. Based on these articles, open questions and areas for future research were identified for this review. CONCLUSION Several major gaps in the literature on the diagnosis and treatment of isolated snoring were identified. For the majority of diagnostic and therapeutic measures for snoring, high-level scientific evidence is still lacking.
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Affiliation(s)
- B Hofauer
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Freiburg, Killianstr. 5, 79106, Freiburg, Germany. .,Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
| | - B Braumann
- Department of Maxillofacial Surgery/Orthodontics, University of Cologne, Cologne, Germany
| | - C Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - M Herzog
- Department of Otorhinolaryngology/Head and Neck Surgery, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J T Maurer
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - S Plößl
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Halle, Halle, Germany
| | - J U Sommer
- Department of Otorhinolaryngology/Head and Neck Surgery, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - A Steffen
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - T Verse
- Department of Otorhinolaryngology/Head and Neck Surgery, Asklepios Hospital Hamburg Harburg, Hamburg, Germany
| | - B A Stuck
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital Marburg, Philipps-Universit Marburg, Marburg, Germany
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A. Stuck B, Hofauer B. The Diagnosis and Treatment of Snoring in Adults. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:817-824. [PMID: 31888795 PMCID: PMC6947688 DOI: 10.3238/arztebl.2019.0817] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 08/11/2019] [Accepted: 09/23/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Snoring in adults is a common cause of distress for patients and their bedpartners and calls for appropriate counseling, diagnostic evaluation, and treatment. METHODS A systematic literature search in the PubMed, Cochrane Library, Web of Science Core Collection, and ClinicalTrials.gov databases was carried out in February 2018 and yielded pertinent publications from 2000 onward. The guideline was created according to the methodological requirements of the Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der wissenschaft- lichen medizinischen Fachgesellschaften, AWMF). RESULTS The diagnostic evaluation of snoring is based on the history and phyical examination. In certain situations, a specialized sleep study should be performed to obtain objec- tive findings. The recommended methods of conservative treatment include, in particular, positioning therapy and weight loss. Mandibular protrusion splints can lessen snoring in suitable cases. If breathing through the nose is impaired, rhinological or rhinosurgical treatment is recommended; for certain anatomical abnormalities of the soft palate, a suitable minimally invasive surgical procedure can be considered. The level of the available evidence is low, as most of the under- lying clinical studies involved small patient groups and short follow-up. CONCLUSION In the treatment of snoring, evidence-based recommendations derived from the findings of randomized trials can be given for selected situations, yet the overall state of the evidence on many diagnostic and therapeutic tech- niques remains limited.
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Affiliation(s)
- Boris A. Stuck
- Department of Otolaryngology / Head & Neck Surgery, University Hospital Giessen and Marburg, Philipps-Universität Marburg
| | - Benedikt Hofauer
- Department of Otolaryngology / Head & Neck Surgery, University Medical Center Freiburg, All participants in the clinical practice guideline The Diagnosis and Treatment of Snoring in Adults are listed in Box 1
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S3-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sanchez-Ariza CA. Tratamiento con dispositivos orales para síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El objetivo de este artículo es mejorar la práctica con dispositivos orales (DO) por parte del odontólogo tratante, al alcanzar una adecuada selección del DO y brindar seguridad y efectividad al paciente. Con el uso de estos, se intenta disminuir la frecuencia o duración de los eventos respiratorios. Los DO están indicados en pacientes con ronquido primario, síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) leve-moderado y SAHOS severo que no quieran o no toleren tratamiento con presión positiva. Además, se clasifican en aparatos de retención de lengua, aparatos no ajustables y ajustables, siendo estos últimos los más recomendados por ser dispositivos de avance mandibular (DAM), pues son hechos a la medida, ajustables y de arco dual. Su mecanismo de acción consiste en protruisión del maxilar inferior, adelantamiento del hueso hioides y apertura mandibular.Los DAM son más eficaces en pacientes jóvenes, con menor índice de masa corporal (IMC), circunferencia de cuello reducida, SAHOS posicional y mandíbula retrognática. Se pueden presentar efectos adversos como salivación excesiva, cambios oclusales y trastornos temporomandibulares. Se ha demostrado que los DAM tienen un impacto en la disminución del índice de apnea-hipopnea (IAH) y somnolencia diurna, mejoría en la oxigenación nocturna, función cardiovascular, calidad de vida y comportamiento neurocognitivo. Asimismo, los DAM son superiores al tratamiento con presión positiva de vía aérea (PAP) en adherencia. Se sugiere que la terapia combinada de DAM con PAP y otros tratamientos es promisoria para aquellos pacientes que responden de manera insuficiente a la monoterapia.
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Zhu Y, Long H, Jian F, Lin J, Zhu J, Gao M, Lai W. The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. J Dent 2015; 43:1394-402. [PMID: 26485532 DOI: 10.1016/j.jdent.2015.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/08/2015] [Accepted: 10/14/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of oral appliances (OAs) for managing patients with obstructive sleep apnea (OSA). METHODS PubMed, Embase, Web of Science, CENTRAL and SIGLE were electronically searched from January 1980 to September 2015 for randomized or nonrandomized controlled trials that assessed the effectiveness of OAs on OSAS. The processes of study search, selection, data extraction, assessment of risk of bias and evaluation of evidence quality were conducted independently by two reviewer authors. Meta-analyses were performed in Review Manager 5, Stata11.0 and StatsDirect 2.7.9. RESULTS Finally, we included 17 eligible studies which compared OAs and placebo or blank control. Six outcomes were assessed in this meta-analysis, i.e., apnea hypopnea index (AHI), respiratory arousal index (RAI), minimum oxygen saturation(MinSaO2), rapid eye movement (REM) sleep, sleep efficiency and Epworth Sleepiness Scale (ESS). Meta-analysis revealed that the pooled mean differences were -10.26 [95% CI: (-12.59, -7.93)], -9.03 [95% CI: (-11.89, -6.17)], 3.08 [95% CI: (1.97, 4.19)], 0.36 [95% CI: (-0.30, 1.02)], 1.34 [95% CI: (-0.05, 2.73)] and -1.76 [95% CI: (-2.57, -0.94)], respectively. The sensitivity analysis and subgroup analysis displayed generally robust results except for MinSaO2, REM sleep and sleep efficiency. Furthermore, publication bias was detected in RAI and MinSaO2. CONCLUSIONS The available evidence indicates benefits in respiration and sleep quality with oral appliances as compared to placebo devices or blank control, while we cannot determine its effectiveness in sleep efficiency and sleep architecture alterations. However, due to low evidence quality as revealed by GRADE, this finding should be interpreted with caution. CLINICAL SIGNIFICANCE Through critical meta-analyses, we found that oral appliances are effective in respiration improving and sleep quality. The existing evidence supports the employment of OAs as a recommendable treatment option for OSA. This meta-analysis helps to direct clinical practice and future research, and promises to be of great interest for both practitioners and researchers.
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Affiliation(s)
- Yafen Zhu
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hu Long
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fan Jian
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jianchang Lin
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jingyi Zhu
- Department of stomatology, Kiang Wu Hospital, Macao, China
| | - Meiya Gao
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wenli Lai
- Department of Orthodontics, State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Alfredo Santamaría C, David Astudillo O. Vía aérea superior, ronquido e implicancias clínicas. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mangano A, Mangano A. Re: Randomised cross-over study of oral appliances for snoring: a study-design note. Clin Otolaryngol 2011; 36:91-2; author reply 92-3. [PMID: 21414167 DOI: 10.1111/j.1749-4486.2010.02247.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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