Sleep medicine · 2026
Comparative effectiveness of Mandibular advancement devices and Continuous positive airway pressure in adults with obstructive sleep Apnea: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gupta Abhishek Kumar, Narula Vashi, Sharma Swati, Sharma Ankit, Kumari Saroj
Аннотация
BACKGROUND: Obstructive sleep apnea (OSA) is characterized by recurrent upper airway collapse, intermittent hypoxia, and sleep fragmentation. Continuous positive airway pressure (CPAP) is the standard treatment, although long-term adherence is often limited. Mandibular advancement devices (MADs) are increasingly used as an alternative therapy.
OBJECTIVE: To evaluate the effectiveness of MADs compared with CPAP and sham/control interventions in improving apnea-hypopnea index (AHI) and related clinical outcomes in adults with OSA.
METHODS: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Randomized controlled trials comparing MADs with CPAP or sham/control interventions were included. Meta-analysis was performed using random-effects restricted maximum likelihood models with Generic Inverse Variance methodology. For crossover trials, paired standard deviations were imputed using the Elbourne method.
RESULTS: Eight randomized controlled trials involving 642 participants were included. Compared with CPAP, MAD therapy showed significantly higher residual AHI values, favoring CPAP (MD = 11.83 events/hour; 95% CI: 6.61-17.04; I2 = 97.75%). This estimate should be interpreted cautiously because extreme heterogeneity limits precision. Compared with sham/control devices, MADs significantly improved AHI (MD = -15.78 events/hour; 95% CI: -23.13 to -8.43; I2 = 86.47%). Secondary outcomes showed variable but generally favorable responses.
CONCLUSION: CPAP remains the most effective therapy for reducing respiratory events in OSA, while limited evidence suggests MADs may offer benefit compared with sham/control interventions and remain an alternative for patients intolerant of or poorly adherent to CPAP. Interpretation should remain cautious given substantial heterogeneity and limited sham-controlled evidence available.
OBJECTIVE: To evaluate the effectiveness of MADs compared with CPAP and sham/control interventions in improving apnea-hypopnea index (AHI) and related clinical outcomes in adults with OSA.
METHODS: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Randomized controlled trials comparing MADs with CPAP or sham/control interventions were included. Meta-analysis was performed using random-effects restricted maximum likelihood models with Generic Inverse Variance methodology. For crossover trials, paired standard deviations were imputed using the Elbourne method.
RESULTS: Eight randomized controlled trials involving 642 participants were included. Compared with CPAP, MAD therapy showed significantly higher residual AHI values, favoring CPAP (MD = 11.83 events/hour; 95% CI: 6.61-17.04; I2 = 97.75%). This estimate should be interpreted cautiously because extreme heterogeneity limits precision. Compared with sham/control devices, MADs significantly improved AHI (MD = -15.78 events/hour; 95% CI: -23.13 to -8.43; I2 = 86.47%). Secondary outcomes showed variable but generally favorable responses.
CONCLUSION: CPAP remains the most effective therapy for reducing respiratory events in OSA, while limited evidence suggests MADs may offer benefit compared with sham/control interventions and remain an alternative for patients intolerant of or poorly adherent to CPAP. Interpretation should remain cautious given substantial heterogeneity and limited sham-controlled evidence available.