Effectiveness of a fully digital mandibular advancement appliance compared with CPAP in the treatment of obstructive sleep apnea.

INTRODUCTION

Clinicians often face the decision of recommending Continuous Positive Airway Pressure (CPAP) or a Mandibular Advancement Appliance (MAA) for Obstructive Sleep Apnea (OSA).

OBJECTIVE

The objective of this study was to evaluate the effectiveness of a fully digital workflow MAA and compare its outcomes with CPAP therapy.

METHODS

Twenty adults with OSA confirmed by Type I polysomnography (AHI < 50 events/hour), non-adherent to CPAP, were enrolled in a crossover clinical study. After MAA titration (50% and 75% of maximum protrusion), participants underwent home sleep testing under three conditions: no treatment, CPAP, and MAA. Outcomes included oxygen desaturation index (ODI), snoring score, oxyhemoglobin saturation (SpO₂), hypoxic burden, and mean heart rate. Treatment-induced changes (Δ = treatment - no treatment) were compared using the Wilcoxon signed-rank test (α = 5%).

RESULTS

Both therapies significantly reduced ODI and snoring, compared to baseline. Median ODI decreased from 13.55 events/hour (untreated) to 6.05 with MAA and 5.30 with CPAP. No statistically significant differences were found between MAA and CPAP for ΔODI (p = 0.401), snoring (p = 0.103), hypoxic burden (p = 0.165), or heart rate (p = 0.824). A significant difference in SpO₂ was observed (p = 0.003), favoring CPAP; however, the difference was small.

CONCLUSIONS

The fully digital MAA was effective in reducing oxygen desaturation, snoring, and hypoxic burden, showing no clinically meaningful difference compared with CPAP, supporting its use as a viable therapeutic alternative for OSA.