Comparison of CPAP and Oral Appliance Therapy

When it became apparent that Oral Appliance Therapy was a legitimate and desirable part of the treatment mix, questions naturally arose regarding its comparative effectiveness with positive airway pressure modalities. Recently, four studies have focused on Oral Appliance Therapy going head to head with nasal CPAP. Three of them used a cross-over design and the fourth a parallel group design. All of the investigations were randomized, controlled treatment trials. Each of the studies focused on effectiveness as a product of the treatment efficacy in combination with acceptance and adherence to treatment. Treatment efficacy was similar in all the trials and did not deviate significantly from past investigations. It was shown that Oral Appliance Therapy often, but not always decreased the apnea-hypopnea index whereas CPAP nearly always resolved sleep disordered breathing entirely. Acceptance and adherence to treatment with CPAP was limited while that of Oral Appliance Therapy was less so resulting in the proportion of successfully treated patients being about the same in each study. In all three cross-over trials where patients were asked to choose a preferred treatment, the majority chose oral appliance therapy.

Bibliography:
1. Ferguson, KA,Ono T, Lowe AA, et al. A randomized cross-over study of an oral appliance vs nasal CPAP in the treatment of mild-moderate OSA Chest 1996; 190: 1269-1275
2. Ferguson KA, Ono T, Lowe AA, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild-moderate OSA. Thorax 1997; 52:326-368
3. Clark GT, Blumenfeld I, Yoffe N, et al. A cross-over study comparing the efficacy of CPAP with anteriorly mandibular positioning devices on patients with OSA. Chest 1996; 109:1477-1483
4. Lowe AA, Sjoholm TT, Ryan CF, et al. Treatment, airway and compliance effects of a titratable oral appliance. Sleep (in press)


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