Untreated obstructive sleep apnea (OSA) is associated with impaired health-related quality of life (QoL) and excessive daytime sleepiness which have been shown to improve with treatment. The aim was to compare the effects of continuous positive airway pressure (CPAP) and mandibular advancement devices (MAD) on health-related QoL in OSA.
MEDLINE and Cochrane Library were searched up to November 2015. Randomized controlled trials (RCTs) comparing the effect of CPAP, MADs or an inactive control on health-related QoL assessed by the 36-item short form (SF-36) in OSA. Extraction of study characteristics, quality and bias assessment were independently performed by three authors. A network meta-analysis using multivariate random-effects meta-regression was performed to assess treatment effects on the mental (MCS) and physical (PCS) component summary scores of the SF-36.
Of 1491 identified studies, 23 RCTs were included in the meta-analysis (2342 patients). Compared with an inactive control, CPAP was associated with a 1.7 point (95%CI 0.1-3.2, p=0.036) improvement in the MCS and a 1.7 point (95%CI 0.5-2.9, p=0.005) improvement in the PCS. MAD was associated with a 2.4 points (95%CI 0.0-4.9, p=0.053) and a 1.5 point (95%CI -0.2-3.2, p=0.076) improvement in the MCS and PCS, respectively, compared to inactive controls. There were no statistically significant differences in treatment effects on the SF-36 scores between CPAP and MAD.
CPAP is effective in improving health-related quality of life in OSA, and MADs may be just as effective but further RCTs comparing the two treatments are required.