CPAP significantly reduced the apnea-hypopnea index compared to mandibular advancement devices (MD 8.68; 95% CI 4.66-12.71; p<0.01), though MADs improved adherence.
Meta-Analysis (n=1,498)
Does mandibular advancement device (MAD) improve health outcomes compared to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea?
While CPAP remains superior for sleep parameters and OSA symptom relief, MAD offers better adherence and modest blood pressure reductions, making it a practical alternative for CPAP-intolerant patients.
Effect estimate: MD 8.68 (95% CI 4.66 to 12.71)
p-value: p=<0.01
Abstract Introduction Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that increases the risk of cardiovascular diseases. While continuous positive apnea pressure (CPAP) remains in first-line therapy for OSA, poor adherence continues to be a concern. Recently, mandibular advancement devices (MADs) have emerged as a safe and effective alternative. This systematic review and meta-analysis aim to compare MAD and CPAP across several health outcomes. Methods Following PRISMA guidelines, six databases were searched, and the protocol was preregistered on PROSPERO (CRD420251081182). Primary outcomes include apnea-hypopnea index (AHI), peripheral capillary oxygen saturation (SpO2), and several blood pressure (BP) parameters. Secondary outcomes include adherence, oxygen-desaturation index (ODI), among others. A meta-analysis was performed using R version 4.4.3 and heterogeneity was assessed using I2 statistics. Results A total of 17 studies were included with 1,498 observations. The CPAP group showed a significant reduction in AHI (MD = 8.68, 95% CI: 4.66 to 12.71; p 0.01) and improvement in SpO2 (MD = -5.06, 95% CI: -6.32 to -3.81; p 0.01). The MAD group showed a meaningful improvement in adherence (MD = 1.55, 95% CI: 0.95 to 2.16; p 0.01) and modest significant reduction in several BP parameters. Conclusion This review demonstrates that MAD may improve cardiovascular outcomes and offers better adherence, making it a practical alternative for patients unable to tolerate CPAP. CPAP remains superior for sleep parameters and OSA symptom relief. MAD appears safe and effective, supporting further long-term trials to assess cardiovascular outcomes. Support (if any)
Bruciaga et al. (Fri,) conducted a meta-analysis in Obstructive sleep apnea (OSA) (n=1,498). Mandibular advancement devices (MAD) vs. Continuous positive airway pressure (CPAP) was evaluated on Apnea-hypopnea index (AHI) (MD 8.68, 95% CI 4.66 to 12.71, p=<0.01). CPAP significantly reduced the apnea-hypopnea index compared to mandibular advancement devices (MD 8.68; 95% CI 4.66-12.71; p<0.01), though MADs improved adherence.
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