Comparative Efficacy of Continuous Positive Airway Pressure and Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: A Systematic Review

Obstructive Sleep Apnea is a prevalent condition linked to various health issues, including cardiovascular disease and cognitive decline. This systematic review evaluates the comparative efficacy and patient adherence of two primary treatment modalities: Continuous Positive Airway Pressure and Mandibular Advancement Devices. This review incorporates studies from 2004 to 2024, applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and focusing on randomised controlled trials. Continuous Positive Airway Pressure is widely recognised as the gold standard for treating moderate to severe OSA, effectively reducing the Apnea-Hypopnea Index and improving oxygenation. However, its adherence rates are low due to discomfort from the mask and machine noise. Conversely, Mandibular Advancement Devices therapy offers a less invasive alternative with better adherence, especially for patients with mild to moderate Obstructive Sleep Apnea. Despite being less effective than Continuous Positive Airway Pressure in Apnea-Hypopnea Index reduction, Mandibular Advancement Devices demonstrate significant improvements in sleep quality, cognitive function and patient compliance. Continuous Positive Airway Pressure and Mandibular Advancement Devices significantly enhance patient outcomes, but adherence plays a crucial role in determining long-term success. Future research should investigate hybrid treatments combining Continuous Positive Airway Pressure and Mandibular Advancement Devices to optimise patient comfort and efficacy.