Self-reported sleep quality with mandibular advancement device or continuous positive airway pressure: A randomized clinical trial on patients with mild and moderate obstructive sleep apnea

Abstract

Study objectives To compare self-reported sleep quality, treatment compliance and respiratory event index (REI) after 4 months of treatment with mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) in mild and moderate obstructive sleep apnea (OSA). Methods 104 patients with mild or moderate OSA were randomly allocated to MAD or CPAP treatment, and followed for 4 months. Data was collected through type 3 polygraphic sleep recordings, CPAP recordings, medical examination and the Pittsburgh Sleep Quality Index (PSQI). Chi-square test, t-test and Mann-Whitney U test were used to analyze compliance, PSQI global score and REI respectively. Reliable change index (RCI) was used to evaluate change in PSQI global score. Results 6 patients were lost to follow-up. More patients were compliant to MAD treatment (79.5%) than CPAP treatment (38.9%) at follow-up (p<0.001). Both groups improved PSQI global score: MAD (8.0±3.1 to 5.7±2.5, p<0.001) and CPAP (7.7±3.5 to 6.7±3.4, p=0.01). More patients improved PSQI global score according to the RCI in the MAD group (38.6%) than in the CPAP group (16.7%) (p=0.01). Both treatments reduced REI (p<0.001), but CPAP (REI=1.1) more so than MAD (REI=7.9) (p<0.001). Conclusion Both MAD and CPAP treatment improve self-reported sleep quality in patients with mild and moderate OSA. More patients comply with MAD treatment which improve sleep quality in more patients than CPAP do, despite REI being lower in the CPAP group. In respect to sleep quality, MAD treatment should be considered a better treatment option than CPAP in mild and moderate OSA.