Comparative effects of CPAP and mandibular advancement devices in obstructive sleep apnea: an overview of systematic reviews.

PURPOSE: This overview of systematic reviews aimed to compare continuous positive airway pressure and mandibular advancement devices for the treatment of obstructive sleep apnea by distinguishing objective physiological outcomes from patient-centered outcomes and critically appraising the methodological quality of the available evidence.

METHODS

Following PRISMA guidelines and PROSPERO registration (CRD42021268587), we systematically searched five databases to identify systematic reviews comparing continuous positive airway pressure and mandibular advancement devices in obstructive sleep apnea based on a PICO framework. The outcomes of interest included the Apnea-Hypopnea Index, oxygen desaturation index, treatment adherence, and quality of life. Methodological quality was assessed using AMSTAR-2, and overlap among reviews was evaluated using a citation matrix and the corrected covered area.

RESULTS

Fourteen systematic reviews were included. CPAP demonstrated greater efficacy than mandibular advancement devices in improving objective physiological outcomes, particularly the apnea-hypopnea index and oxygen desaturation indices. Both therapies showed comparable effects on daytime sleepiness, while some reviews reported better treatment adherence and more favorable patient-centered outcomes with MADs. Methodological quality was limited: no review was classified as high quality, and most were assessed as low or critically low quality. Analysis of the corrected coverage area indicated a high overlap between the primary studies included in the different reviews.

CONCLUSION

Continuous positive airway pressure is more effective than mandibular advancement devices in improving the apnea-hypopnea index and oxygen desaturation index. However, mandibular advancement devices were associated with positive effects on quality of life and sleep, though certainty regarding the sustainability of these outcomes and their long-term efficacy remains limited in the current literature. Treatment choice should be individualized, and evidence should be interpreted with caution due to methodological limitations and the high overlap between the included systematic reviews.

PROSPERO REGISTRATION NUMBER: CRD2021268587.