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 Millions of patients worldwide wear breathing masks all night to
ease sleep apnea, a common disorder that leads to disrupted
breathing or shallow breaths during sleep. The masks are connected
to a machine that provides continuous positive airway pressure (CPAP),
which splints the airway open with an airstream so the upper airway
can’t collapse during sleep.
Even though CPAP is safe and effective and often doctors’ first
choice, some patients can’t tolerate wearing the masks all night
long. For these people, doctors may offer an alternative known as
mandibular advancement devices (MAD), which open up space in the
airway by pushing out the lower jaw bone to make it less likely that
the upper airway collapses during sleep.
Researchers analyzed data from 67 studies with almost 6,900 patients
and found patients had a greater reduction in daytime sleepiness
with CPAP than with MAD.
But both options were effective enough that the choice of device
might be left up to patients’ preferences, said senior study author
Dr. Malcolm Kohler, chair of respiratory medicine at the University
Hospital of Zurich in Switzerland.
“Most doctors still consider CPAP as first-line treatment for
patients with obstructive sleep apnea,” Kohler said by email. “If a
patient cannot really use CPAP adequately e.g. only two to three
hours per night, but does fine with a MAD which he can tolerate for
seven hours a night, then he should be treated with a MAD.”
Kohler and colleagues reviewed previous research on the two
treatments for patients with sleep apnea to see how they compared in
reducing sleepiness based on a standard 0 to 24 point scale known as
the Epworth Sleepiness Scale (ESS).
Higher scores indicate greater degrees of daytime sleepiness based
on questions that focus on how often people doze off during
different daytime situations and activities.
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People in the study who got CPAP had typical ESS scores that were
2.5 points lower than people in control groups who didn’t receive
treatment, the analysis found.
By comparison, people in the study who got MAD had average ESS
scores 1.7 points lower than control groups.
The findings confirm that both CPAP and MAD reduce daytime
sleepiness, and the analysis also reinforces that MAD is a good
alternative for patients who can’t tolerate CPAP, said Dr. Ferran
Barbe, who wrote an editorial accompanying the study with colleague
Manual Sanchez-de-la-Torre of the respiratory department at the
Hospital Universitari Arnau de Vilanova and Santa Maria in Lleida,
Spain.
“There are lots of studies focused on CPAP effects and less evidence
with MAD,” Barbe said by email. “However, in clinical practice MAD
also works. The take-home is that we have two good treatments for
obstructive sleep apnea.”
SOURCE: http://bit.ly/1Y9Pmnr The Lancet Respiratory Medicine,
online October 20, 2015.
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