Although CPAP attenuated central sleep apnea, improved nocturnal oxygenation, increased the ejection fraction, lowered norepinephrine levels, and increased the distance walked in six minutes, it did not affect survival. Our data do not support the use of CPAP to extend life in patients who have central sleep apnea and heart failure.

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Obstructive sleep apnoea (OSA) is a common disorder that can present with various clinical Background -Although oral appliances are effective in some patients with ob-consequences.1 Nasal continuous positive airway pressure therapy (nCPAP) is a highly structive sleep apnoea (OSA), they are not universally effective. A novel anterior effective treatment for OSA, 2 but there can be substantial problems with patient acceptance mandibular positioner (AMP) has been developed with an adjustable hinge that and long term compliance.3 The most common surgical treatment for OSA is uvulopalatoallows progressive advancement of the mandible. The objective of this prospective pharyngoplasty (UPPP) but this approach is limited by its variable success. 4 Consequently, crossover study was to compare efficacy, side effects, patient compliance, and pref-there is a need for alternative treatments for OSA that are safe, effective, and acceptable. erence between AMP and nasal continuous positive airway pressure (nCPAP) in Oral appliances represent a relatively new approach in the management of OSA. 5 Schmidtpatients with symptomatic mild to moderate OSA.Nowara and co-workers have reported their experience with a mandibular repositioning apMethods -Twenty four patients of mean (SD) age 44.0 (10.6) years were recruited pliance in 68 patients with either snoring or OSA. 6 In the 20 patients with follow up polywith a mean (SD) body mass index of 32.0 (8.2) kg/m 2 , Epworth sleepiness score 10.7 somnography the appliance reduced the apnoea and hypopnoea index (AHI) by more than 50% (3.4), and apnoea/hypopnoea index 26.8 (11.9)/hour. There was a two week wash-and improved both arterial oxygen saturation and sleep quality. O'Sullivan and co-workers in and a two week wash-out period and two treatment periods (AMP and nCPAP) have recently shown that a mandibular advancement splint decreased AHI to <20/hour each of four months. Efficacy, side effects, compliance, and preference were evalu-in 12 of 17 patients in whom untreated AHI was 20-60 per hour, and in two of nine patients ated by a questionnaire and home sleep monitoring.in whom untreated AHI was >60/hour. 7 Eveloff and colleagues reported their results with an Results -One patient dropped out early in the study and three refused to cross over anterior mandibular positioning appliance in 19 patients with OSA. 8 Their success rate was so treatment results are presented on the remaining 20 patients. The apnoea/hypo-53% when they defined treatment response as a reduction in AHI to <10/hour with the pnoea index (AHI) was lower with nasal CPAP 4.2 (2.2)/hour than with the AMP appliance. Division of (14.5)/hour (p<0.01). Eleven of the 20There are major design differences in the

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There is increasing evidence suggesting that OA improves subjective sleepiness and sleep disordered breathing compared with a control. CPAP appears to be more effective in improving sleep disordered breathing than OA. The difference in symptomatic response between these two treatments is not significant, although it is not possible to exclude an effect in favour of either therapy. Until there is more definitive evidence on the effectiveness of OA in relation to CPAP, with regard to symptoms and long-term complications, it would appear to be appropriate to recommend OA therapy to patients with mild symptomatic OSAH, and those patients who are unwilling or unable to tolerate CPAP therapy. Future research should recruit patients with more severe symptoms of sleepiness, to establish whether the response to therapy differs between subgroups in terms of quality of life, symptoms and persistence with usage. Long-term data on cardiovascular health are required.