The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis
ABSTRACT Background:A systematic review and meta-analysis was performed to compare the outcomes of oral appliances (OA) with those of continuous positive airway pressure (CPAP) in treatment of patients with obstructive sleep apnea (OSA).Methods:Relevant studies were retrieved from the following electronic databases up to and including Semptember 2012: MEDLINE, PubMed, EMBASE, and Central Register of Controlled Trials. Main outcomes were epworth sleepiness scale (ESS), health-related quality of life, cognitive performance, blood pressure, apnoea and hypopnoea index (AHI), arousal Index (AI), minimum saturation (Min SaO2), rapid eye movement sleep, % (REM%), treatment usage, side effects, treatment preference and withdrawals.Results:Fourteen trials were finally included in this review. Our results demonstrated that the effects on ESS (p=0.31 and 0.09 in cross-over and parallel-group trials), health-related quality of life, cognitive performance, and blood pressure of OA and CPAP were similar. Besides, pooled estimates of cross-over trials suggested a significant difference in favor of CPAP regarding AHI (p<0.00001), AI (p=0.001), and Min SaO2 (p<0.00001), while pooled estimates of parallel-group trials showed a significant difference in favor of CPAP regarding AHI (p<0.00001) and REM% (p=0.02). Moreover, OA and CPAP yielded fairly similar results in terms of treatment usage (p=0.26, hours/night in cross-over trials and p=0.14, hours/night; p=0.19, nights/week in parallel-group trials), treatment preference, side effects and withdrawals (p=0.34 in parallel- group trials).Conclusions:CPAP yielded better PSG outcomes especially in reducing AHI than OA, indicating that OA was less effective than CPAP in improving sleep disordered breathing. However, similar results from OA and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer OA to patients who are unable or unwilling to persist with CPAP.
- Hypertension 12/2013; 63(2). DOI:10.1161/HYPERTENSIONAHA.113.00613 · 7.63 Impact Factor
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ABSTRACT: Abstract Background: Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. Aims: To underscore the importance of diagnosing and treating OSA in women with schizophrenia. Methods: A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. Results: The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. Conclusion: Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.Journal of Mental Health 01/2014; 23(4):191-196. DOI:10.3109/09638237.2013.869572 · 1.01 Impact Factor
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ABSTRACT: Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for Obstructive Sleep Apnoea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard Continuous Positive Airway Pressure (CPAP) treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography, however this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 02/2014; 10(2):215-227. DOI:10.5664/jcsm.3460 · 2.83 Impact Factor