The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu, Sichuan, China.
Respiratory care (Impact Factor: 1.84). 01/2013; 58(7). DOI: 10.4187/respcare.02245
Source: PubMed


A systematic review and meta-analysis was performed to compare the outcomes of oral appliances (OAs) with those of CPAP in treatment of patients with obstructive sleep apnea (OSA).

Relevant studies were retrieved from the following electronic databases, up to and including September 2012: MEDLINE, PubMed, EMBASE, and Central Register of Controlled Trials. The main outcomes were Epworth Sleepiness Scale score, health-related quality of life, cognitive performance, blood pressure, apnea-hypopnea index (AHI), arousal index, minimum SpO2, percent rapid eye movement sleep, treatment usage, side effects, treatment preference, and withdrawals.

Fourteen trials were finally included in this review. Our results demonstrated that the effects on Epworth Sleepiness Scale score (P = .31 and .09 in crossover and parallel-group trials), health-related quality of life, cognitive performance, and blood pressure of OAs and CPAP were similar. Besides, pooled estimates of crossover trials suggested a significant difference in favor of CPAP regarding AHI (P < .001), arousal index (P = .001), and minimum SpO2 (P < .001), while pooled estimates of parallel-group trials showed a significant difference in favor of CPAP regarding AHI (P < .001) and percent rapid eye movement sleep (P = .02). Moreover, OAs and CPAP yielded fairly similar results in terms of treatment usage (P = .26 for hours/night in crossover trials, and P = .14 for hours/night and P = .19 for nights/week in parallel-group trials), treatment preference, side effects, and withdrawals (P = .34 in parallel-group trials).

CPAP yielded better polysomnography outcomes, especially in reducing AHI, than OAs, indicating that OAs were less effective than CPAP in improving sleep-disordered breathing. However, similar results from OAs and CPAP in terms of clinical and other related outcomes were found, suggesting that it would appear proper to offer OAs to patients who are unable or unwilling to persist with CPAP.

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    • "Mandibular repositioning devices enlarge the upper airway during sleep by holding the mandible in a forward position. They are efficacious treatment alternatives for patients with mild-to-moderate [12] or supine-position-dependent [13] OSAHS, or in those who are noncompliant with CPAP. The effects of MRDs on sleep-disordered breathing are usually inferior to CPAP, especially for apnoea– hypopnoea index (AHI) reductions, but patient acceptability may be better [14], with similar QOL and symptom effects. "
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    ABSTRACT: Background: Mandibular repositioning devices (MRDs) are usually recommended as the first therapy option in patients with mild-to-moderate obstructive sleep apnoea (OSA). However, data on the long-term efficacy of MRDs are limited, not only in OSA patients who are noncompliant with continuous positive airway pressure (CPAP) but also in those with more severe OSA. The ORCADES study aimed to prospectively determine the long-term efficacy and tolerability of two custom-made Narval(™) MRDs for obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. The interim 3- to 6-month data are reported. Methods: Eligible patients had OSAHS and had refused or were noncompliant with prescribed CPAP. Outcome measurements after gradual mandibular advancement titration included: apnoea-hypopnoea index (AHI), oxygen saturation, sleepiness, symptoms, quality of life, side effects and compliance. Results: A total of 369 patients were included. Overall, MRD treatment was successful (≥50% decrease in AHI) in 76.2% of the participants; complete response (AHI <10/h) was achieved in 63.5%. Severe OSAHS was effectively treated (AHI <15/h) in about 60% of the participants; 38% had complete symptom resolution. Mandibular repositioning devices significantly decreased subjective sleepiness, eliminated symptoms and improved quality of life. They were well tolerated and compliance was excellent. Only 8% of the participants stopped MRD treatment due to side effects. Conclusion: Custom-made Narval(™) MRDs are effective for mild to severe OSA in patients who refuse or are noncompliant with CPAP. They are well tolerated and have excellent compliance.
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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.
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