In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea

Smart mandibular advancement devices for obstructive sleep apnea: a systematic literature review

PURPOSE

The goal of this review is to provide sleep physicians, dentists, and researchers with an evidence-based overview of the literature on smart mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea.

METHODS

A systematic literature search was conducted by two blinded reviewers and an information specialist. A smart MAD was defined as any MAD with additional functionality besides mandibular protrusion. The bibliographic databases Medline, Embase, and Scopus were used to identify relevant publications. Studies were included if they described any stage of development of smart MADs. A total of 3162 titles and abstracts were screened for their relevance. In total, 58 articles were selected for full-text screening, 26 of which were included in this review.

RESULTS

The overall quality of the available literature was low. Most of the studies were observational, clinical or applied-research articles. The authors classified MADs into two main groups: passive and active. Passive MADs measured patient data, most commonly patient compliance. Active MADs adjusted protrusion of the mandible in response to patient data and were found in various phases of technological readiness (in development, demonstration, or deployment).

CONCLUSION

Innovations in smart mandibular advancement devices most frequently track patient compliance. Devices measuring other health parameters and active, feedback-controlled, devices are increasingly reported on. However, studies demonstrating their added benefit over traditional methods remain sparse. With further study, smart mandibular advancement devices have the potential to improve the efficiency of obstructive sleep apnea treatment and provide new treatment possibilities.

The role of oral appliance therapy in obstructive sleep apnoea

There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.

The role of artificial intelligence in the treatment of obstructive sleep apnea

BACKGROUND

The first-line and most common treatment for obstructive sleep apnea is nasal continuous positive airway pressure, which serves as a pneumatic splint to stabilize the upper airway and is effective when used with appropriate adherence. Continuous positive airway pressure compliance rates remain significantly low despite machine improvements and compliance intervention. Other treatment options include oral appliances, myofunctional therapy, and surgery. The aim of this project is to elucidate the role of artificial intelligence within improving the treatment of obstructive sleep apnea.

METHODS

Related publications between 1999 and 2022 were reviewed from PubMed and Embase databases utilizing search terms "artificial intelligence," "machine learning," "obstructive sleep apnea," and "treatment." Both authors independently screened the results by title/abstract then by full text review. 126 non-duplicate articles were screened, 38 articles were included after title and abstract screen and 30 articles were included after full text review. The inclusion criteria are outline in the PICO framework and involved studies focused on artificial intelligence application in guiding and evaluating obstructive sleep apnea treatment. Non-English articles were excluded.

RESULTS

The role of artificial intelligence in the treatment of OSA was categorized into the following sections: Predicting treatment outcomes of various treatment options, Improving/Evaluating treatment, and Personalizing treatment with improving understanding of underlying mechanisms of OSA.

CONCLUSIONS

Artificial intelligence has the capacity to improve the treatment of OSA through predicting outcomes of treatment options, evaluating the treatment the patient is currently utilizing and increasing understanding of the mechanisms that contribute to OSA disease process and physiology. Implementing AI in guiding treatment decisions allows patients to connect with treatment methods that would be most effective on an individual basis.