Long-Term Therapeutic Efficacy of Mandibular Advancement Device Compared to Continuous Positive Airway Pressure in Patients With Obstructive Sleep Apnea.

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) are both established treatment options.

OBJECTIVE

To evaluate and compare the long-term objective and subjective therapeutic efficacy of MADs and CPAP in adults with OSA.

METHODS

Fifty-nine patients diagnosed with OSA based on polysomnography (PSG) and the apnea-hypopnea index (AHI) were enrolled and allocated to either MAD (n = 30) or CPAP (n = 29) treatment groups. Follow-up PSGs were conducted at 1 and 5 years for MAD users, with their devices in situ, while CPAP data were obtained from the device data card. Adherence, daytime sleepiness, and quality of life were assessed throughout the study.

RESULTS

At five years, 44 patients (22 MAD, 22 CPAP) remained in the study. Mean AHI significantly decreased from 31.83 ± 16.57 to 9.01 ± 5.14 episodes/h (p < 0.001) in the MAD group, and from 35.11 ± 12.25 to 3.47 ± 3.12 episodes/h (p < 0.001) in the CPAP group. Self-reported adherence averaged 7.29 ± 1.12 h/night for MAD, while CPAP adherence averaged 4.94 ± 1.68 h/night. Daytime sleepiness and quality of life improved in both groups.

CONCLUSION

CPAP and MADs demonstrated both sustained long-term efficacy in treating OSA and comparable improvements in subjective outcomes. CPAP was significantly more effective in reducing AHI, and MADs were associated with better adherence.