Efficacy of Mandibular Advancement Devices vs. CPAP
SOURCE: Kuhn E, et al. Chest 2017;151:786-794.
Although there are “organic” rewards for the treatment of obstructive sleep apnea (OSA), such as blood pressure reduction in hypertensives, much of the benefit of intervention resides in the quality of life (QOL) category: less daytime fatigue, better concentration, less snoring, etc. Despite such favorable effects, short- and long-term compliance with continuous positive airway pressure (CPAP) often is difficult. How does the efficacy of mandibular advancement devices (MANDs) for QOL compare?
Kuhn et al performed a network metaanalysis of clinical trials (n = 23) that compared CPAP and/or MANDs to inactive control. The outcome of interest was QOL as assessed by the mental and physical components of the SF-36 score. Both CPAP and MANDs resulted in improved physical and mental segments of the SF-36 score, and there was no statistically significant difference between the two methods in efficacy.
MANDs often been prescribed for patients with less severe OSA (mild-moderate), for patients who could not tolerate CPAP, or for persons for whom CPAP was not effective. These results suggest that MANDs are a viable alternative. The authors recommended that CPAP should remain the first-line treatment for most patients, perhaps because the studies employing MANDs have been restricted to less severe OSA cases.
Authors a recent paper recommended that continuous positive airway pressure should remain the first-line treatment for most patients, perhaps because the studies employing mandibular advancement devices have been restricted to less severe obstructive sleep apnea cases.
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