Continuous Positive Airway Pressure vs Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: An Updated Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 35251830 · doi:10.7759/cureus.21759
What was done
A systematic review and meta-analysis comparing the efficacy of continuous positive airway pressure (CPAP) versus mandibular advancement devices (MADs) in mild to severe obstructive sleep apnea (OSA). Searches were conducted in PubMed and Cochrane in May 2021. Randomized controlled trials (parallel and crossover) reporting pre- and post-treatment apnea-hypopnea index (AHI), lowest oxygen saturation, and Epworth Sleepiness Scale (ESS) scores were pooled using random-effects models.
What was found
Eight randomized studies met inclusion criteria: - AHI: CPAP significantly reduced AHI compared to MAD (mean difference -5.83, 95% CI: -8.85 to -2.81, P < 0.01). - Lowest oxygen saturation: Difference favored CPAP (mean difference 0.72, 95% CI: 0.51 to 0.94, P < 0.01). - ESS: No statistically significant difference between CPAP and MAD (mean difference 0.23, 95% CI: -0.24 to 0.70, P = 0.34).
Why it matters
This review supports CPAP as the superior intervention for objective polysomnographic indices (AHI and oxygenation), while showing MADs offer comparable relief for subjective daytime sleepiness.
Limits
The total number of randomized participants was not reported in the abstract. The meta-analysis included only eight studies with heterogeneous treatment durations. Treatment adherence, long-term cardiovascular outcomes, and adverse effects were not reported.
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