Sleep medicine · Device alternatives to CPAP
Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea
| Design | Randomised crossover trial |
|---|---|
| Treatment | Mandibular advancement device |
| Control | CPAP |
| Population | 126 patients with moderate to severe obstructive sleep apnoea |
| Follow-up | 1 month per treatment period |
| Primary endpoint | Health outcomes including blood pressure, sleepiness, quality of life and neurobehavioural function |
| Result | CPAP reduced the apnoea-hypopnoea index more than the oral appliance (4.5±6.6 versus 11.1±12.1 per hour) but was used for fewer hours. Neither device lowered 24-hour mean arterial pressure, the primary outcome, and health outcomes were similar after one month of each. 126 patients with moderate-to-severe apnoea (mean AHI 25.6) were randomised and 108 completed both treatments. |
| Secondary endpoints | Apnoea-hypopnoea index, adherence, patient preference |
Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA. The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD.
The trial authors, in the published abstract
The single most useful idea in sleep apnoea therapeutics — effectiveness is efficacy multiplied by adherence. It explains why an inferior device ties with a superior one, and why the adherence figures in SAVE matter so much to that trial's interpretation.
Phillips CL, Grunstein RR, Darendeliler MA, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 2013 Apr 15;187(8):879-87.