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The purpose of this systematic review is to investigate the effectiveness of different MAD designs in AHI reduction and oxygen saturation improvement in OSA patients. An electronic search was performed in MEDLINE, Cochrane Database, Scopus, Web of Knowledge and LILACS. Randomised controlled trials (RCTs) investigating the reduction of AHI on adult patients wearing MAD for OSA were included. 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 randomised controlled trial. The success rate of each study was computed: [(mean baseline AHI\u00a0\u2212\u00a0mean AHI after treatment)\/mean baseline AHI]. Fifty RCTs were included. The risk of bias resulted with some concerns in most of the studies. The GRADE scores indicated that the quality of evidence was very low. The meta\u2010analysis showed a success rate with mono\u2010bloc and duo\u2010bloc MADs respectively of 0.821 [0.722\u20100.887] and 0.547 [0.443\u20100.637]. The mono\u2010bloc compared with duo\u2010bloc better improved the minimum oxygen saturation (10.048 [7.733\u201012.363] and 3.357 [2.290\u20104.423], respectively). There is a very low quality body of evidence that mono\u2010bloc MADs are more effective in reducing AHI and improving minimum oxygen saturation compared with duo\u2010bloc MADs. The study protocol was registered on PROSPERO (n. 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