Diagnosis and Treatment of Obstructive Sleep Apnea in Adults
Comparative Effectiveness of Continuous Positive Airway Pressure Machines Versus Mandibular Advancement Devices
There is a moderate strength of evidence that continuous positive airway pressure (CPAP) and mandibular advancement devices (MAD) are effective treatments for obstructive sleep apnea and improve sleepiness and lower apnea-hypopnea index (AHI) values when compared to control treatments or no treatment. There is also a moderate strength of evidence that CPAP is superior to MAD in achieving an AHI of ≤ 5 events per hour. However, there is insufficient evidence to determine which patients might benefit most from treatment with CPAP, MAD, or CPAP compared to MAD. Note that studies of MAD predominantly exclude patients with comorbidities or unsafe levels of sleepiness. It is also important to note that current research evaluates only intermediate outcomes, and thus these findings may not apply to long-term clinical outcomes.
Keywords: outcomes | treatment | strength of evidence | continuous positive airway pressure | mandibular advancement device | CPAP | MAD | AHI | apnea-hypopnea index | oral device
- Balk EM, Moorthy D, Obadan NO, et al. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults. Comparative Effectiveness Review No. 32 (Prepared by Tufts Evidence-based Practice Center under Contract No. 290-2007-10055-I). Rockville, MD: Agency for Healthcare Research and Quality; July 2011. AHRQ Publication No. 11-EHC052-EF.
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