Continuous Positive Airway Pressure vs Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: An Updated Systematic Review and Meta-Analysis

Abstract

Introduction: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder which has various treatment options, however, continuous positive airway pressure (CPAP) remains the gold standard. The aim of this meta-analysis is to compare the current first-line treatment of OSA, i.e., the continuous positive airway pressure (CPAP) with mandibular advancement devices (MADs) in mild to severe OSA.Objective: This meta-analysis is a comparison of the efficacy of continuous positive airway pressure vs mandibular advancement devices in patients with mild to severe obstructive sleep apnea. The primary objective of the meta-analysis is to compare the efficacy of CPAP vs MADs in the treatment of OSA. This meta-analysis includes randomized control and cross-over studies that compare the efficacy of CPAP and MAD and outcomes are reported in terms of apnea-hypopnea index (AHI), lowest oxygen saturation, and Epworth sleepiness scale both pre-and post-treatment.Data sources and study selection: A PubMed and Cochrane database search was conducted in May 2021 and study bibliographies were reviewed. Randomized clinical trials comparing the effect of CPAP and MAD on AHI, lowest oxygen saturation, and ESS in patients with obstructive sleep apnea were selected. Of the 436 studies initially identified, eight were selected for analysis after screening. The quantitative measures used for comparing the efficacy of CPAP and MAD were post-treatment apnea-hypopnea index (AHI), lowest oxygen saturation, and post-treatment Epworth score scale (ESS).Data extraction and synthesis: A network of meta-analyses was performed using RevMan (Copenhagen, Denmark: Nordic Cochrane Center) where multivariate random-effects models were used to generate pooled estimates. Data were analyzed using generic inverse variance method and P < 0.05 is regarded as statistically significant. Combined summary statistics of standardized (STD) paired difference in mean for individual studies and combined studies was calculated. A chi-square-based test of homogeneity was performed and the inconsistency index (I 2 ) statistic was determined.Results: Compared the AHI, lowest oxygen saturation, and ESS from baseline to follow-up pre-and posttreatment in both CPAP and MAD groups; after the database search 436 records were identified, eight studies were included in the RCT, and three were RCT crossover studies. The duration of treatment varies in each group. AHI, ESS, and lowest oxygen saturation are calculated pre-and post-treatment. Compared with MAD, CPAP was associated with decrease in AHI with a mean difference of -5.83 (95% CI, -8.85, -2.81, P < 0.01). The lowest oxygen saturation was also decreased in CPAP group compared to MAD group with a mean difference of 0.72 (95% CI, 0.51, 0.94, P < 0.01). However, there was no statistically significant difference in ESS between CPAP and MAD group with a mean difference of 0.23 (95% CI, -0.24, 0.70, P = 0.34). The metaanalysis states that among patients with obstructive sleep apnea, both CPAP and MADs are effecti...

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review

“…Since different treatments exhibit different mechanisms of action and the collapse of the upper airway occurs at multiple levels in most subjects with OSA [ 70 , 71 ], combined treatments could improve the overall therapeutic effectiveness. In this regard, MAD may be successfully combined with CPAP and nasal expiratory positive airway pressure (EPAP) with a further reduction of the AHI compared to the single therapy [ 72 – 75 ].…”

Perioperative management of Obstructive Sleep Apnoea: Present themes and future directions

“…Mandibular advancement devices (MADs), which reduce airway obstruction through advancement of the jaw, are a second line therapy. Although less effective for severe disease, they are better tolerated than PAP, and MADs may provide similar health outcomes to PAP therapy due to this [79,80]. The prevention of sleep apnea after general anaesthesia with a MAD (POMAD) trial [81] is currently recruiting and will provide useful data.…”

Beyond Counting Sheep: Exploring the Link between Polycystic Ovary Syndrome and Sleep Health

“…It is important that treatment of OSA should not be generalized across both adults and adolescents with PCOS as younger individuals could also report lower OSA symptom profiles. 105 Appliance-based treatments including CPAP or mandibular advancement splints may be efficacious, 106 but consideration must be given to adherence and tolerability. Taken together, a forward-looking focus of OSA treatment in PCOS patients should prioritize the management of symptoms, 31,60 with the benefits of longer-term health risk reduction remaining to be established.…”