• 8-year retrospective study of cardiovascular mortality in patients with severe OSA showed that CPAP and OAT may be equally effective in reducing the risk of fatal cardiovascular events in severe OSA patients
    (Anandam, A. et al (2013) “Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: An observational study.” )

 

  • Among patients with OSA, both CPAP and MADs were associated with reductions in blood pressure. Network meta-analysis did not identify a statistically significant difference between the BP outcomes (absolute change in SBP and DBP from baseline to follow-up) associated with these therapies
    (Bratton D.J. et al (2015) “CPAP vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea. A systematic review and Meta-analysis.” JAMA)

 

  • Single-blind RCT (29 moderate and severe OSA patients) comparing MAD, CPAP, and placebo OAT found that improved compliance with OAT compared to CPAP favored the reduction of one of the enzymes (catalase) which participates in oxidative stress and better autonomic modulation during sleep
    (Dal-Fabbro C. et al (2014) “Mandibular advancement device and CPAP upon cardiovascular parameters in OSA.” Sleep and Breathing)

 

  • RCT comparing effects of MAD vs CPAP in 28 moderate to severe OSA patients without cardiovascular disease…found that after 2 to 3 months, patients in MAD group had significant improvement in amino-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) whereas not following CPAP therapy. This finding indicates an improvement of cardiac function following effective OAT
    (Hoekema, A. et al (2008) “Effects of oral appliances and CPAP on the left ventricle and natriuretic peptides.” Int J Cardiol)

 

  • Randomized crossover trial comparing health effects of 1 month use of MAD vs CPAP. CPAP was more effective at reducing AHI, but compliance was higher in MAD (50 ± 1.3 h per night vs. CPAP, 5.20 ± 2 h per night).  24-hour mean arterial pressure was similar between MAD and CPAP.  Sleepiness, driving simulator performance, and disease-specific quality of life improved on both treatments by similar amounts, although MAD was superior to CPAP for improving four general quality-of-life domains
    (Phillips C.L. et al (2013) “Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial.” Am J Respir Crit Care Med)

 

  • Prospective, non-randomized controlled trial evaluating 215 SDB patients consecutively treated with OAT found significant differences in energy/vitality and physical role limitation following 4 months with OAT, indicating improved health-related QoL
    (Johal A. (2006) “Health-related quality of life in patients with sleep-disordered breathing: effect of mandibular advancement appliances.” J Prosthet Dent.)

 

  • Crossover trial of OSA patients (AHI 34+/-13 events/hr) involving 8 weeks MAD, 8 weeks CPAP. Median (interquartile range) AHI was 2 (1-8) events/hr with CPAP and 6 (3-14) events/hr with MAD (p<0.001), showing CPAP was more effective at reducing this measure.  Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL.  The reported compliance was higher for MAD with >70% of patients preferring this treatment.
    (Gagnadoux, F. (2009) “Titrated mandibular advancement versus positive airway pressure for sleep apnoea” Eur Respir J.)

 

  • Cohort study evaluating subjective and objective measures in patients with mild to severe OSA undergoing treatment with MAD or CPAP. Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes.  Authors concluded that OAT should be considered a viable treatment alternative to CPAP in patients with mild to moderate OSA
    (Doff, M.H.J. et al (2013) “Oral appliances versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up” Sleep)

 

  • Both CPAP and OAT offered comparable benefits for veterans with PTSD in relation to PTSD severity and health-related quality of life
    (El Solh, A.A. (2017) “A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder” J Clin Sleep Med)

 

  • RCT of 64 mild to moderate OSA patients objectively titrated with nasal CPAP (nCPAP) or MAD and followed up with PSG after 6 monts. No differences in the ΔAHI were found between the MAD and CPAP therapy, whereas the changes in AHI in these groups were significantly larger than those in the placebo group.  Authors concluded that there is no clinically relevant difference between MAD and nCPAP in the treatment of mild/moderate OSA when both treatment modalities are titrated objectively
    (Aarab, G. (2011) “Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial” Respiration)

 

  • Studies have shown the patients use MAD over 6 to 7 hours per night, on average, while in large international cohorts, CPAP use is closer to 3.3 hours per night
    (Demko, B.G. (2018) “The Evolution of Oral Sleep Appliance Therapy for Snoring and Sleep Apnea” Sleep Med Clin)

 

  • A two-year follow-up study found that TMD pain symptoms were higher than at baseline in the OAT group after 2 months (not CPAP group), but no differences from baseline were found at 1 or 2 year follow-up. Furthermore, there was no difference in mandibular function between groups throughout the follow-up period.  Findings suggest OAT may actually help reduce TMD symptoms after initial adjustment period
    (Doff M.H.J. (2012) “Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects” Clin Oral Investig.)

 

  • The AADSM recommends palliative care and watchful waiting for management of OAT side effects, with little need for active intervention
    (Sheats RD (2017) “Management of side effects of oral appliance therapy for sleep disordered breathing” J Dent Sleep Med)