title: Tongue retaining devices for obstructive sleep apnea: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Tongue Retaining Devices (TRD) anteriorly displace the tongue with suction forces while patients sleep. TRD provide a non-surgical treatment option for patients with Obstructive Sleep Apnea (OSA). Our objective was to conduct a systematic review of the international literature for TRD outcomes as treatment for OSA.
  
  
  METHODS
  Three authors independently and systematically searched four databases (including PubMed/MEDLINE) through June 26, 2016. We followed guidelines set within the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
  
  
  RESULTS
  Sixteen studies with 242 patients met criteria. The overall means±standard deviations (M±SD) for apnea-hypopnea index (AHI) decreased from 33.6±21.1/h to 15.8±16.0/h (53% reduction). Seven studies (81 patients) reported lowest oxygen saturation (LSAT), which improved from 79.8±17.5% to 83.9±8.6%. Four studies (93 patients) reported Epworth sleepiness scale (ESS), which decreased from 10.8±4.8 to 8.2±4.5, p <0.0001. Four studies (31 patients) reported Oxygen Desaturation Index (ODI) which decreased from 29.6±32.1 to 12.9±8.7, a 56.4% reduction.
  
  
  CONCLUSIONS
  Current international literature demonstrates that tongue retaining devices reduce apnea-hypopnea index by 53%, increase lowest oxygen saturation by 4.1 oxygen saturation points, decrease oxygen desaturation index by 56% and decrease Epworth sleepiness scale scores by 2.8 points. Tongue retaining devices provide a statistically effective alternative treatment option for obstructive sleep apnea.
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: etchan78@gmail.com.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA. Electronic address: cferna25@gmail.com.
authors.forename: Camilo
authors.initials: C
authors.lastname: Fernandez-Salvador
authors.affiliation: Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: jeremy.giambo@usuhs.edu.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Giambo
authors.affiliation: Uniformed Services University of the Health Sciences, School of Medicine, Bethesda,MD 20814, USA. Electronic address: nicholas.nesbitt@usuhs.edu.
authors.forename: Blaine
authors.initials: B
authors.lastname: Nesbitt
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: stanley.yung.liu@gmail.com.
authors.forename: Stanley Yung-Chuan
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address: rcapasso@stanford.edu.
authors.forename: Robson
authors.initials: R
authors.lastname: Capasso
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: clete@standford.edu.
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.affiliation: Department of Otolaryngology, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, HI, USA; Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine,Stanford Hospital and Clinics, 450 Broadway St. 2nd Floor, Redwood City, CA 94063, USA. Electronic address: drcamachoent@yahoo.com.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
mesh_terms: D004867:Equipment Design; D006801:Humans; D012138:Respiratory Therapy / Q000295:instrumentation*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D014059:Tongue