Drs. George J. Cisneros and Oliver F. Nicolay together with Benjamin J. Goldstein compare the efficacy of oral appliance therapy and CPAP therapy
Sleep-disordered breathing (SDB) is a pathological state in which there is periodic and recurrent snoring and obstructive sleep apnea (OSA).1 Individuals with untreated OSA have associated unfavorable health outcomes such as cardiovascular disease, stroke, hypertension, and atrial fibrillation. Patients also suffer from a decreased quality of life, daytime sleepiness, and an increased mortality rate.2 Continuous positive airway pressure (CPAP) therapy has been proven successful in treating OSA by improving the quality of life (QOL), the Apnea-Hypopnea Index (AHI), and oxygen saturation parameters.3 Despite these improvements, patient compliance and adherence to this treatment has been an issue. Patients either reject this treatment or partially comply with it. In fact, the benefits of CPAP treatment may be negated by poor patient compliance and acceptance.4 Recently, oral appliances have been quite popular in the medical and dental communities in treating OSA. Although CPAP therapy is still the “gold standard” in managing the condition, oral appliance therapy (OAT) has become an acceptable alternative for those patients suffering with mild to moderate OSA because of its ease of use and increased patient compliance. Generally, OAT can be divided into tongue-retaining devices and mandibular advancement devices. This critical analysis of the literature seeks to compare the efficacy of MAD use with CPAP therapy and will focus on already established factors of treatment success that have been recognized in the literature. A PubMed database search was used with the keywords: “Mandibular Advancement Devices,” “Continuous Positive Airway Pressure,” and “Obstructive Sleep Apnea.” No restrictions were placed on the filter search engine.
Educational aims and objectives
The purpose of this article is to present a critical analysis of the literature to compare the efficacy of MAD use with CPAP therapy and focus on already established factors of treatment success that have been recognized in the literature.
Orthodontic Practice US subscribers can answer the CE questions with this quiz to earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can:
- Identify the various symptoms of sleep-disordered breathing.
- Identify various therapies for sleep-disordered breathing.
- Identify the multi-system sleep tests that are used to diagnose sleep disorders.
- Realize the efficacy of both CPAP and MAD therapy on sleep-disordered breathing.
- Recognize some side effects of the various treatments.