Efficacy of advancement treatments of the stomatognathic system on objective sleepiness in OSA: a systematic review
Journal of Clinical Sleep Medicine. 2025-04-22; :
DOI: 10.5664/jcsm.11730
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Galvez P(1)(2)(3), d’Incau E(1)(4)(5), Taillard J(4)(6), Martin VP(4)(7), Carra MC(8)(9), Fenelon M(2)(3), Chuy V(10), Coelho J(1)(4), Philip P(1)(4), Micoulaud-Franchi JA(1)(4).
Author information:
(1)University Sleep Medicine Department, University Hospital of Bordeaux,
F-33076 Bordeaux, France.
(2)Oral Surgery Department, University Hospital of Bordeaux, F-33076 Bordeaux,
France.
(3)University of Bordeaux, INSERM, Laboratory BioTis, UMR 1026, F-33076
Bordeaux, France.
(4)University of Bordeaux, SANPSY, UMR 6033, F-33000, Bordeaux, France.
(5)Service of odontology, University Hospital of Bordeaux, F-33076 Bordeaux,
France.
(6)University of Bordeaux, SANPSY, USR 3413, Bordeaux, France.
(7)University of Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, F-33400,
Talence, France.
(8)Periodontology Department, Service of odontology, Rothschild Hospital
(AP-HP), Paris, France.
(9)Sorbonne Paris Cité, INSERM, Epidemiology and Statistics Research Centre,
Paris, France.
(10)University of Bordeaux, INSERM, BPH, U1219, F-33000 Bordeaux, France.
STUDY OBJECTIVES: Objective sleepiness is an important outcome requiring
rigorous evaluation regarding OSA treatment efficacy, but no systematic review
has explored the efficacy of advancement treatments of the stomatognathic system
(ATSS), i.e. mandibular advancement device (MAD), hypoglossal nerve stimulation
(HNS), and maxillomandibular advancement surgery (MMA), on objective sleepiness
in OSA.
METHODS: We conducted a systematic review of the literature using PubMed, Scopus
and Web of Science databases. All clinical studies assessing the efficacy of
ATSS on objective sleepiness in adults with OSA, by the maintenance of
wakefulness test (MWT), the multiple sleep latency test (MSLT), the Oxford sleep
resistance test (OSLER), the psychomotor vigilance task (PVT) or the sustained
attention to response task (SART), were included.
RESULTS: Among 42 screened studies, 11 were included – 6 randomized controlled
trials (RCTs) and 5 prospective studies. Regarding the RCTs, all assessed MAD
efficacy and only one RCT found a significant improvement of objective
sleepiness for MAD compared with placebo, on the MSLT. In the remaining RCTs,
the included participants did not present objective sleepiness at baseline and
were mostly with mild/moderate OSA. Regarding the prospective studies, all found
a significant improvement of objective sleepiness for each treatment assessed,
i.e. MAD, HNS, MMA and submental stimulation. Interestingly, the included
participants presented objective sleepiness at baseline and moderate/severe OSA.
CONCLUSIONS: This systematic review highlighted the lack of RCTs assessing the
efficacy of MAD or other ATSS on objective sleepiness in OSA. Further RCTs are
needed to address this important outcome taking into account baseline objective
sleepiness and OSA severity.
© 2025 American Academy of Sleep Medicine.
DOI: 10.5664/jcsm.11730
PMID: 40259747