Document Detail

Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial.
MedLine Citation:
PMID:  23413266     Owner:  NLM     Status:  MEDLINE    
RATIONALE: Continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) therapy are commonly used to treat obstructive sleep apnea (OSA). Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes.
OBJECTIVES: To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA.
METHODS: In this randomized crossover trial, we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes.
MEASUREMENTS AND MAIN RESULTS: Cardiovascular (24-h blood pressure, arterial stiffness), neurobehavioral (subjective sleepiness, driving simulator performance), and quality of life (Functional Outcomes of Sleep Questionnaire, Short Form-36) were compared between treatments. Our primary outcome was 24-hour mean arterial pressure. A total of 126 patients with moderate-severe OSA (apnea hypopnea index [AHI], 25.6 [SD 12.3]) were randomly assigned to a treatment order and 108 completed the trial with both devices. CPAP was more efficacious than MAD in reducing AHI (CPAP AHI, 4.5 ± 6.6/h; MAD AHI, 11.1 ± 12.1/h; P < 0.01) but reported compliance was higher on MAD (MAD, 6.50 ± 1.3 h per night vs. CPAP, 5.20 ± 2 h per night; P < 0.00001). The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP (CPAP-MAD difference, 0.2 mm Hg [95% confidence interval, -0.7 to 1.1]); however, overall, neither treatment improved blood pressure. In contrast, 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.
CONCLUSIONS: Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA. The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD, resulting in similar effectiveness. Clinical trial registered with (ACTRN 12607000289415).
Craig L Phillips; Ronald R Grunstein; M Ali Darendeliler; Anastasia S Mihailidou; Vasantha K Srinivasan; Brendon J Yee; Guy B Marks; Peter A Cistulli
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  187     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-16     Completed Date:  2013-06-11     Revised Date:  2013-12-16    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  879-87     Citation Subset:  AIM; IM    
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MeSH Terms
Automobile Driving*
Blood Pressure Monitoring, Ambulatory / instrumentation
Computer Simulation
Continuous Positive Airway Pressure / instrumentation,  methods,  statistics & numerical data*
Cross-Over Studies
Fatigue / etiology,  physiopathology
Hypertension / etiology,  physiopathology
Mandibular Advancement / instrumentation,  methods,  statistics & numerical data*
Middle Aged
New South Wales
Patient Compliance / statistics & numerical data
Polysomnography / instrumentation
Quality of Life*
Severity of Illness Index
Sleep Apnea, Obstructive / complications,  physiopathology,  therapy*
Treatment Outcome
Vascular Stiffness / physiology
Young Adult
Comment In:
Am J Respir Crit Care Med. 2013 Nov 1;188(9):1163-4   [PMID:  24180445 ]
Am J Respir Crit Care Med. 2013 Nov 1;188(9):1162-3   [PMID:  24180444 ]
Am J Respir Crit Care Med. 2013 Nov 1;188(9):1162   [PMID:  24180443 ]
Ann Intern Med. 2013 Oct 15;159(8):JC10   [PMID:  24126659 ]
Am J Respir Crit Care Med. 2013 Apr 15;187(8):795-7   [PMID:  23586381 ]
J Clin Sleep Med. 2013 Sep;9(9):971-2   [PMID:  23997711 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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