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We thank our readers and correspondents for their interest in our umbrella review of therapeutic oral interventions in obstructive sleep apnea (OSA) (1).

As we stated in our materials and methods section, the objective and protocol of our study were defined a priori. The study objective was to assess the evidence base underlying oral interventions in the treatment of OSA, which are of interest to, but not necessarily restricted to dentists or orthodontists. For this reason, continuous positive airway pressure (CPAP), uvulopalatoplasty, and electronically guided hypoglossal nerve stimulators did not fall under this objective. The study by Vicini et al. (2) was excluded from our review since it compared maxillomandibular advancement (MMA) with CPAP, which was not consistent with our selection criteria. Nonetheless, we acknowledge CPAP as first-line therapy for OSA and mentioned this in our discussion section, where the study by Vicini et al. (2) is cited, among others.

We wish to point out that the original objective in our study protocol was to consider not only randomized but also non-randomized prospective studies. Unfortunately, such studies with untreated or placebo-matched control patients for MMA and maxillary expansion could not be identified. We consider this fact astonishing because these procedures are an integral part of the standard protocols for OSA in many hospitals. Therefore, it was concluded that there is no robust scientific evidence to support these treatments at the present time.

Finally, we agree that interdisciplinary approaches have an important role in clinical decision-making, as long as they are supported by high quality studies.

DOI: 10.3238/arztebl.2018.0556b

Dr. med. dent. Vasiliki Koretsi

Abteilung für Kieferorthopädie, Universitätsklinikum Regensburg

koretsi.vasiliki@gmail.com

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

1.
Koretsi V, Eliades T, Papageorgiou SN: Oral interventions for obstructive sleep apnea—an umbrella review of the effectiveness of intraoral appliances, maxillary expansion, and maxillomandibular advancement. Dtsch Arztebl Int 2018; 115: 200–7 VOLLTEXT
2.
Vicini C, Dallan I, Campanini A, et al.: Surgery vs ventilation in adult severe obstructive sleep apnea syndrome. Am J Otolaryngol 2010; 31: 14–20 CrossRef MEDLINE
1.Koretsi V, Eliades T, Papageorgiou SN: Oral interventions for obstructive sleep apnea—an umbrella review of the effectiveness of intraoral appliances, maxillary expansion, and maxillomandibular advancement. Dtsch Arztebl Int 2018; 115: 200–7 VOLLTEXT
2.Vicini C, Dallan I, Campanini A, et al.: Surgery vs ventilation in adult severe obstructive sleep apnea syndrome. Am J Otolaryngol 2010; 31: 14–20 CrossRef MEDLINE

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