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Original Research |

Effects of CPAP and MADs on health-related quality of life in OSA: a systematic review and meta-analysis

Eric Kuhn, MD; Esther I. Schwarz, MD; Daniel J. Bratton, PhD; Valentina A. Rossi, MD; Malcolm Kohler, MD
Author and Funding Information

Conflict of interest statement: None of the authors has any conflict of interest to declare.

Funding: Swiss National Science Foundation (grant 32003B_162534/1) and the University of Zurich Clinical Research Priority Program Sleep and Health.

1Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland

2Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

3Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland

Corresponding author address Prof Malcolm Kohler Chair Respiratory Medicine, Clinical Director Division of Pulmonology and Sleep Disorders Centre University Hospital of Zurich Raemistrasse 100, Zurich, Switzerland.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.020
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Abstract

Background  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.

Methods  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.

Results  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.

Conclusions  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.


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