The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
Health Outcomes of Continuous Positive Airway Pressure versus Oral Appliance Treatment for Obstructive Sleep Apnea: A Randomized Controlled Trial
Abstract
RATIONALE: Continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) therapy are commonly used to treat obstructive sleep apnea (OSA). Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes. OBJECTIVES: To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA. METHODS: In this randomized crossover trial, we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes. MEASUREMENTS AND MAIN RESULTS: Cardiovascular (24-h blood pressure, arterial stiffness), neurobehavioral (subjective sleepiness, driving simulator performance), and quality of life (Functional Outcomes of Sleep Questionnaire, Short Form-36) were compared between treatments. Our primary outcome was 24-hour mean arterial pressure. A total of 126 patients with moderate-severe OSA (apnea hypopnea index [AHI], 25.6 [SD 12.3]) were randomly assigned to a treatment order and 108 completed the trial with both devices. CPAP was more efficacious than MAD in reducing AHI (CPAP AHI, 4.5 ± 6.6/h; MAD AHI, 11.1 ± 12.1/h; P < 0.01) but reported compliance was higher on MAD (MAD, 6.50 ± 1.3 h per night vs. CPAP, 5.20 ± 2 h per night; P < 0.00001). The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP (CPAP-MAD difference, 0.2 mm Hg [95% confidence interval, -0.7 to 1.1]); however, overall, neither treatment improved blood pressure. In contrast, sleepiness, driving simulator performance, and disease-specific quality of life improved on both treatments by similar amounts, although MAD was superior to CPAP for improving four general quality-of-life domains. CONCLUSIONS: Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA. The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD, resulting in similar effectiveness. Clinical trial registered with https://www.anzctr.org.au (ACTRN 12607000289415).
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Citations
Cites
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Adherence to Continuous Positive Airway Pressure Therapy: The Challenge to Effective Treatment
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“However, despite these health-related improvements, many patients either reject treatment outright or only partially tolerate it, resulting in significant residual OSA (15).”
BackgroundSelf-citationVlachopoulos, C., Aznaouridis, K., O'Rourke, M. F., Safar, M. E., Baou, K., & Stefanadis, C. (2010) · European Heart Journal · doi:10.1093/eurheartj/ehq024 · Cited by 1,363 · cited 1×
“Arterial stiffness has increasingly been shown to improve cardiovascular risk stratification (40, 41) and both uncontrolled (33, 42) and randomized controlled studies (43, 44) have shown improvements after CPAP.”
BackgroundObstructive Sleep Apnea–Hypopnea and Incident Stroke: The Sleep Heart Health Study
Redline, S., Yenokyan, G., Gottlieb, D. J., Shahar, E., O'Connor, G. T., Resnick, H. E., Diener-West, M., Sanders, M. H., Wolf, P. A., Geraghty, E. M., et al. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200911-1746oc · Cited by 1,269
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Continuous positive airways pressure for obstructive sleep apnoea in adults
Giles, T., Lasserson, T., Smith, B., White, J., Wright, J., & Cates, C. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001106.pub2 · Cited by 1,001
Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea
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Obstructive sleep apnoea syndrome
Lévy, P., Kohler, M., McNicholas, W. T., Barbé, F., McEvoy, R. D., Somers, V. K., Lavie, L., & Pépin, J.-L. (2015) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2015.15 · Cited by 1,235
Ramar, K., Dort, L. C., Katz, S. G., Lettieri, C. J., Harrod, C. G., Thomas, S. M., & Chervin, R. D. (2015) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.4858 · Cited by 915
Peker, Y., Glantz, H., Eulenburg, C., Wegscheider, K., Herlitz, J., & Thunström, E. (2016) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201601-0088oc · Cited by 756
Obstructive Sleep Apnea in Adults
Veasey, S. C., & Rosen, I. M. (2019) · New England Journal of Medicine · doi:10.1056/nejmcp1816152 · Cited by 615
Oral Appliance Treatment for Obstructive Sleep Apnea: An Update
Sutherland, K., Vanderveken, O. M., Tsuda, H., Marklund, M., Gagnadoux, F., Kushida, C. A., Cistulli, P. A., & on behalf of the ORANGE-Registry (Oral Appliance Network on Global Effectiveness) (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3460 · Cited by 515
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Metadata
- Authors
- Phillips, C. L., Grunstein, R. R., Darendeliler, M. A., Mihailidou, A. S., Srinivasan, V. K., Yee, B. J., Marks, G. B., & Cistulli, P. A.
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-04-15
- Volume
- 187
- Issue
- 8
- Pages
- 879-887
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2143712404
- Cited by
- 572
- References
- 19
- FWCI
- 33.26
- Type
- journal article
- Language
- en
- Open access
- closed
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