Continuous Positive Airway Pressure Versus Mandibular Advancement Devices Impact on Cardio-Metabolic Outcomes in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Obstructive sleep apnea contributes to cardiovascular morbidity, and its treatment may mitigate this risk. Continuous positive airway pressure and mandibular advancement devices are established therapies, but their comparative cardiometabolic effects remain uncertain. We conducted a systematic review and meta-analysis of randomised controlled trials from multiple major databases through May 2024, pooling dichotomous outcomes as risk ratios and continuous outcomes as mean differences with 95% confidence intervals using StataMP version 17. Across 14 randomised trials including 1241 patients, CPAP showed clear advantages over MAD. CPAP significantly reduced low-density lipoprotein (MD -15.20 mg/dL; 95% CI -28.86 to -1.53), total cholesterol (MD -17.10 mg/dL; 95% CI -30.15 to -4.05) and dipping diastolic blood pressure (MD -3.12 mmHg; 95% CI -5.62 to -0.62). No meaningful differences emerged between the two therapies for serum glucose, HDL, triglycerides, 24-h mean blood pressure, systolic or diastolic pressures during sleep or wakefulness, or heart rate metrics. Overall, CPAP demonstrated superior lipid and diastolic blood pressure improvement compared with MAD, pointing towards a more favourable cardiometabolic profile. Both interventions remain effective treatments for OSA, yet CPAP may provide added benefit in reducing cardiovascular risk factors and appears to be the preferred modality in patients with elevated cardiometabolic risk.