Comparative evaluation of Continuous positive airway pressure and mandibular advancement device in the treatment of obstructive sleep apnea: a systematic review and meta-analysis

Abstract

BACKGROUND: The goal of this study was to review relevant randomized controlled trials in order to determine efficacy of continuous positive airway pressure (CPAP) with those mandibular advancement devices (MAD) in treatment of patients with obstructive sleep apnea (OSA).

METHODS: An electronic search was performed using appropriate keywords, in MEDLINE, PubMed, EMBASE, and Cochrane Library from 2018 to November 2021, to select randomised controlled trials (RCTs) comparing the effects of continuous positive airway pressure, mandibular advancement devices in reducing Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale score in adult OSA patients. Inclusion criteria were the diagnosis of OSA and success evaluation performed with a polysomnography, follow-up of 12 months. The processes of study search, selection, data extraction, assessment of risk of bias and evaluation of evidence quality were conducted independently by two reviewer authors. Meta-analyses were performed in Review Manager 5, Stata 11.0 and Sta's Direct 2.7.9.

RESULTS: Five RCTs were finally included in this review. A total 121 patients in CPAP group and 103 in the MAD group. Compared with MAD, CPAP significantly decreased AHI (WMD: 3.33, 95%CI: 0.05, 6.60). However, in Epworth sleepiness scale score after therapy between MAD group 59 patients and CPAP group 75 patients there was no significant difference seen in both groups (WMD: 0.59, 95%CI:-1.60,2.77).

CONCLUSION: CPAP yielded better polysomnography outcomes, especially in reducing AHI, than MAD. Though, similar results from MAD and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer MAD to patients who were intolerable to CPAP.