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Original Research: Sleep Disorders |

Effects of CPAP and Mandibular Advancement Devices 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

Drs Kuhn and Schwarz are co-first authors and contributed equally to this manuscript.

FUNDING/SUPPORT: This work was supported by the Swiss National Science Foundation [Grant No. 32003B_162534/1] and the University of Zurich Clinical Research Priority Program Sleep and Health.

aSleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland

bCenter for Integrative Human Physiology, University of Zurich, Zurich, Switzerland

cCenter for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland

CORRESPONDENCE TO: Malcolm Kohler, MD, Division of Pulmonology and Sleep Disorders Centre, University Hospital of Zurich, Raemistrasse 100, Zurich, Switzerland


Copyright 2017, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):786-794. doi:10.1016/j.chest.2017.01.020
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Background  Untreated 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 CPAP and a mandibular advancement device (MAD) on health-related QoL in OSA.

Methods  MEDLINE and the Cochrane Library were searched up to November 2015 for randomized controlled trials (RCTs) comparing the effect of CPAP, MADs, or an inactive control treatment on health-related QoL assessed by the 36-Item Short Form Health Survey (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 component score (MCS) and the physical component score (PCS) of the SF-36.

Results  Of 1,491 identified studies, 23 RCTs were included in the meta-analysis (2,342 patients). Compared with an inactive control, CPAP was associated with a 1.7 point (95% CI, 0.1-3.2; P = .036) improvement in the MCS and a 1.7 point (95% CI, 0.5-2.9; P = .005) improvement in the PCS. MADs were associated with a 2.4 point (95% CI, 0.0-4.9; P = .053) and a 1.5 point (95% CI, –0.2 to 3.2; P = .076) improvement in the MCS and PCS, respectively, compared with inactive control treatments. There were no statistically significant differences between treatment effects of CPAP and MAD on the SF-36 scores.

Conclusions  CPAP is effective in improving health-related QoL in OSA, and MADs may be just as effective, but further RCTs comparing the two treatments are required.

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