In this randomized controlled trial, patients with nonsevere obstructive sleep apnea (OSA) were treated with continuous positive airway pressure (CPAP) or a twin block mandibular advancement splint (MAS). The primary objective was to compare how CPAP and MAS treatments change the health-related quality of life (HRQoL) and self-reported sleep quality of patients after 12 months of treatment. In total, 104 patients were recruited: 55 were allocated to the CPAP treatment group and 49 to the MAS treatment group. We used the SF36 questionnaire to evaluate HRQoL and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. All patients were included in the intention-to-treat analyses. These analyses showed improvements in the SF36 physical component score (from 48.8 ± 7.6 at baseline to 50.5 ± 8.0 at follow-up, p=0.03) in the CPAP treatment group and in the mental component score (from 44.9 ± 12.1 to 49.3 ± 9.2, p=0.009) in the MAS treatment group. The PSQI global score improved in both the CPAP (from 7.7 ± 3.5 to 6.6 ± 2.9, p=0.006) and the MAS (8.0 ± 3.1 to 6.1 ± 2.6, p<0.001) treatment groups. No difference was found between the treatment groups in any of the SF36 scores or PSQI global score at the final follow-up (p>0.05) in any analysis. The improvement in the SF36 vitality domain moderately correlated to the improvement in the PSQI global score in both groups (CPAP: r=0.47, p<0.001; MAS: r=0.36, p=0.01). In the MAS treatment group, we also found a weak correlation between improvements in the SF36 mental component score and PSQI global score (r=0.28, p=0.05). In conclusion, CPAP and MAS treatments lead to similar improvements in the HRQoL and self-reported sleep quality in nonsevere OSA. Improvements in aspects of HRQoL seem to be moderately correlated to the self-reported sleep quality in both CPAP and MAS treatments.

Nonsevere obstructive sleep apnea (OSA) is most often treated with a continuous positive airway pressure (CPAP) device or a mandibular advancement splint (MAS). However, patient compliance with these treatments is difficult to predict. Improvement in apnea-hypopnea index (AHI) is also somewhat unpredictable in MAS treatment. In this study, we investigated the association between Friedman tongue position score (Friedman score) and both treatment compliance and AHI improvement in patients with nonsevere OSA receiving CPAP or MAS treatment. 104 patients with nonsevere OSA were randomly allocated to CPAP or MAS treatment and followed for 12 months. Data were collected through a medical examination, questionnaires, sleep recordings from ambulatory type 3 polygraphic sleep recording devices, and CPAP recordings. Associations between Friedman score, treatment compliance, and AHI improvement were analysed with logistic regression analyses. Friedman score was not associated with treatment compliance (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.59-1.23), or AHI improvement (OR: 1.05, 95% CI: 0.62-1.76) in the overall study sample, the CPAP treatment group, or the MAS treatment group. Adjustment for socioeconomic factors, body mass index, and tonsil size did not significantly impact the results. Although Friedman score may predict OSA severity and contribute to the prediction of success in uvulopalatopharyngoplasty, we found no association between Friedman score and treatment compliance in patients with nonsevere OSA receiving CPAP or MAS treatment, nor did we find any association between Friedman score and AHI improvement. Factors other than Friedman score should be considered when deciding whether a patient with nonsevere OSA should be treated with CPAP or MAS.

Study Objectives: To compare self-reported sleep quality, treatment compliance, and respiratory event index (REI) after 4 months of treatment with mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) in mild and moderate obstructive sleep apnea (OSA). Materials and Methods: A total of 104 patients with mild or moderate OSA were randomly allocated to MAD or CPAP treatment and followed for 4 months. Data were collected through type 3 polygraphic sleep recordings, CPAP recordings, medical examination, and the Pittsburgh Sleep Quality Index (PSQI). Chi-square test, t-test, and Mann-Whitney U test were used to analyze compliance, PSQI global score and REI, respectively. Reliable change index (RCI) was used to evaluate change in PSQI global score. Results: Six patients were lost to follow-up. More patients were compliant with MAD treatment (79.5%) than CPAP treatment (38.9%) at follow-up (P<0.001). Both groups had improved PSQI global scores: MAD (8.0±3.1 to 5.7±2.5, P<0.001) and CPAP (7.7±3.5 to 6.7±3.4, P=0.01). More patients had improved PSQI global score according to the RCI in the MAD group (38.6%) than in the CPAP group (16.7%) (P=0.01). Both treatments reduced REI (P<0.001), but CPAP (REI=1.1) more so than MAD (REI=7.9) (P<0.001). Conclusions: Both MAD and CPAP treatment improve self-reported sleep quality in patients with mild and moderate OSA. More patients comply with MAD treatment, which improves sleep quality in more patients than does CPAP, despite REI being lower in the CPAP group. With respect to sleep quality, MAD treatment should be considered a better treatment option than CPAP in mild and moderate OSA.