CPAP trumps mandibular devices

Thursday, 22 Oct 2015

Continuous positive airway pressure is more effective than mandibular advancement devices for reducing daytime sleepiness in people with OSA, a meta-analysis in the Lancet Respiratory Medicine concludes.

The network meta-analysis of 67 studies involving 6873 patients found that CPAP was associated with a reduction in ESS score of 2·5 points and mandibular advancement devices of 1·7 points compared to an inactive control.

On average CPAP reduced the ESS score by a further 0·8 points compared with mandibular advancement devices, the researchers estimated, noting that there was a possibility of publication bias.

“CPAP should be the first-line treatment for obstructive sleep apnoea whereas mandibular advancement devices should be regarded as an effective alternative when patients cannot tolerate continuous positive airway pressure,” concluded the study authors from Zurich in Switzerland.

The finding that longer continuous positive airway pressure usage per night was not associated with a better outcome required further investigation, they added.

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