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Diagnosis and Treatment of Obstructive Sleep Apnea in Adults

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Meta-analysis of Apnea-hypopnea Index in Randomized Controlled Trials of MAD Versus CPAP

Overall, nine trials provided data on apnea-hypopnea index (AHI) outcomes; all trials reported that AHI was lower among patients on continuous positive airway pressure (CPAP) than among those using mandibular advancement devices (MAD). The results were statistically significant in seven of the trials. Meta-analysis of the nine trials with adequate data found that the difference in AHI between MAD and CPAP was statistically significant, favoring CPAP (difference = 7.7 events per hour; 95 percent CI = 5.3, 10.1; P <0.001). Analysis of the net difference assessed in the two parallel trials and of the difference of final values in the six crossover trials yielded similar findings. However, the trial results were statistically heterogeneous due to the different devices being tested.