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Mandibular Advancement Device versus CPAP in Severe Obstructive Sleep Apnea
J T Colpani1, Y-H Ou2, A M Kosasih2
1Discipline of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore.
Journal of Dental Research
|September 1, 2025
Summary
Mandibular advancement devices (MADs) effectively reduced blood pressure in severe obstructive sleep apnea (OSA) patients. While both MADs and continuous positive airway pressure (CPAP) improved quality of life, MADs showed a greater impact on blood pressure control.
Area of Science:
- Cardiology
- Sleep Medicine
- Respiratory Medicine
Background:
- Severe obstructive sleep apnea (OSA) is associated with increased cardiovascular risk.
- Continuous positive airway pressure (CPAP) is the primary treatment, but adherence can be challenging.
- Mandibular advancement devices (MADs) present an alternative treatment option for OSA.
Purpose of the Study:
- To compare the effectiveness of MADs versus CPAP in managing cardiovascular parameters and quality of life in patients with severe OSA.
- To evaluate the impact of MADs and CPAP on 24-h ambulatory blood pressure, myocardial remodeling, heart rhythm, and biomarkers.
Main Methods:
- A substudy of a randomized trial involving 144 participants with severe OSA, randomized to MAD (n=73) or CPAP (n=71) for 12 months.
- Assessed 24-h ambulatory blood pressure, sleep-related quality of life (including Epworth Sleepiness Scale), cardiac MRI parameters, ambulatory heart rhythm, and biomarkers.
- Nightly device usage and adherence were recorded.
Main Results:
- MAD treatment significantly reduced asleep mean, systolic, and diastolic blood pressure compared to baseline.
- CPAP did not show significant changes in asleep blood pressure.
- Between-group analysis favored MAD for reductions in asleep mean and systolic blood pressure.
- Both devices improved sleep-related quality of life, with CPAP showing a slightly greater effect on the Epworth Sleepiness Scale.
- No significant changes were observed in cardiac MRI, heart rhythm, or biomarkers.
- MADs were associated with jaw pain and teeth discomfort, while CPAP users reported dry mouth, nasal congestion, and air leakage.
Conclusions:
- Mandibular advancement devices (MADs) are an acceptable and effective treatment for severe obstructive sleep apnea (OSA), particularly for reducing blood pressure in hypertensive patients.
- Both MADs and CPAP improve sleep-related quality of life, but MADs offer a distinct advantage in blood pressure management.
- The findings support MADs as a viable alternative to CPAP for select patients with severe OSA and hypertension.
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