Non-Cochrane · intervention · PM42340217
Continuous Positive Airway Pressure Versus Mandibular Advancement Devices Impact on Cardio-Metabolic Outcomes in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
Manasrah AlMothana, Tanashat Mohammad, Ghaly Ramy, et al. · Journal of sleep research · 2026 · PubMed · doi:10.1111/jsr.70351
Findings
Population Adults with obstructive sleep apnea
38 findings
| CPAP | Mandibular advancement device (MAD) | 24-h mean diastolic blood pressure Crossover RCTs | MD -0.14 [-1.98, 1.69] GRADE not reported 4 studies · 530 participants |
| CPAP | Mandibular advancement device (MAD) | Asleep mean arterial pressure | MD 0.81 [-1.45, 3.07] GRADE not reported 3 studies · 334 participants |
| CPAP | Mandibular advancement device (MAD) | Functional Outcomes of Sleep Questionnaire (FOSQ) score Parallel-group RCTs | MD 1.22 [0.15, 2.29] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | 24-h mean systolic blood pressure Crossover RCTs | MD -0.09 [-2.09, 1.92] GRADE not reported 4 studies · 530 participants |
| CPAP | Mandibular advancement device (MAD) | Asleep (night) systolic blood pressure | MD 0.21 [-1.92, 2.34] GRADE not reported 7 studies · 677 participants |
| CPAP | Mandibular advancement device (MAD) | Asleep (night) systolic blood pressure Parallel-group RCTs | MD 1.53 [-1.72, 4.78] GRADE not reported 4 studies · 355 participants |
| CPAP | Mandibular advancement device (MAD) | Epworth Sleepiness Scale score | MD 0.29 [0.19, 0.39] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | 24-h mean diastolic blood pressure Parallel-group RCTs | MD 0.70 [-1.43, 2.82] GRADE not reported 3 studies · 287 participants |
| CPAP | Mandibular advancement device (MAD) | Asleep diastolic blood pressure | MD 0.14 [-1.30, 1.57] GRADE not reported 7 studies · 677 participants |
| CPAP | Mandibular advancement device (MAD) | Diastolic blood pressure dipping | MD -3.12 [-5.62, -0.63] GRADE not reported 3 studies · 146 participants |
| CPAP | Mandibular advancement device (MAD) | Awake systolic blood pressure Parallel-group RCTs | MD 1.72 [-1.21, 4.64] GRADE not reported 4 studies · 355 participants |
| CPAP | Mandibular advancement device (MAD) | 24-h mean arterial pressure | MD 0.61 [-1.40, 2.62] GRADE not reported 3 studies · 337 participants |
| CPAP | Mandibular advancement device (MAD) | 24-h mean diastolic blood pressure | MD 0.22 [-1.17, 1.60] GRADE not reported 7 studies · 817 participants |
| CPAP | Mandibular advancement device (MAD) | 24-h mean heart rate | MD -0.67 [-3.28, 1.94] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | 24-h mean systolic blood pressure Parallel-group RCTs | MD 1.58 [-1.65, 4.80] GRADE not reported 3 studies · 287 participants |
| CPAP | Mandibular advancement device (MAD) | Glucose | MD 1.37 [-3.17, 5.91] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Asleep heart rate | MD -0.56 [-3.05, 1.93] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Systolic blood pressure dipping | MD -0.96 [-3.45, 1.53] GRADE not reported 3 studies · 146 participants |
| CPAP | Mandibular advancement device (MAD) | Body mass index Sensitivity analysis omitting Schutz et al. 2013 | MD 1.22 [0.15, 2.28] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Awake diastolic blood pressure Crossover RCTs | MD -0.38 [-2.30, 1.54] GRADE not reported 3 studies · 322 participants |
| CPAP | Mandibular advancement device (MAD) | 24-h mean systolic blood pressure | MD 0.38 [-1.33, 2.08] GRADE not reported 7 studies · 817 participants |
| CPAP | Mandibular advancement device (MAD) | Awake systolic blood pressure Crossover RCTs | MD 0.09 [-2.68, 2.86] GRADE not reported 3 studies · 322 participants |
| CPAP | Mandibular advancement device (MAD) | High-density lipoprotein cholesterol | MD -1.20 [-8.75, 6.35] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Asleep diastolic blood pressure Parallel-group RCTs | MD 1.26 [-0.83, 3.35] GRADE not reported 4 studies · 355 participants |
| CPAP | Mandibular advancement device (MAD) | Awake heart rate | MD -1.40 [-4.29, 1.49] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Waist circumference | MD 2.82 [-0.81, 6.45] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Asleep (night) systolic blood pressure Crossover RCTs | MD -0.79 [-3.60, 2.03] GRADE not reported 3 studies · 322 participants |
| CPAP | Mandibular advancement device (MAD) | Triglycerides | MD -25.18 [-57.11, 6.76] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Awake diastolic blood pressure Parallel-group RCTs | MD 0.48 [-1.60, 2.55] GRADE not reported 4 studies · 355 participants |
| CPAP | Mandibular advancement device (MAD) | Awake mean arterial pressure | MD 0.37 [-1.72, 2.47] GRADE not reported 3 studies · 337 participants |
| CPAP | Mandibular advancement device (MAD) | Awake systolic blood pressure | MD 0.86 [-1.15, 2.87] GRADE not reported 7 studies · 677 participants |
| CPAP | Mandibular advancement device (MAD) | Body mass index | MD 0.56 [-1.02, 2.14] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Low-density lipoprotein cholesterol | MD -15.20 [-28.86, -1.53] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Neck circumference | MD 0.42 [-0.55, 1.39] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Awake diastolic blood pressure | MD 0.01 [-1.39, 1.42] GRADE not reported 7 studies · 677 participants |
| CPAP | Mandibular advancement device (MAD) | Asleep diastolic blood pressure Crossover RCTs | MD -0.86 [-2.82, 1.11] GRADE not reported 3 studies · 322 participants |
| CPAP | Mandibular advancement device (MAD) | Total cholesterol | MD -17.10 [-30.15, -4.05] GRADE not reported Studies not reported |
| CPAP | Mandibular advancement device (MAD) | Functional Outcomes of Sleep Questionnaire (FOSQ) score | MD 0 [-0.05, 0.05] GRADE not reported Studies not reported |
Included primary studies 24
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Barnes 2004 Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea DOI:10.1164/rccm.200311-1571oc | 2004 | this review only | not stated | not extracted yet |
| Barnes et al. 2004 Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. PMID:15201136 | 2004 | this review only | not stated | not extracted yet |
| Dal-Fabbro 2014 Mandibular advancement device and CPAP upon cardiovascular parameters in OSA DOI:10.1007/s11325-014-0937-5 | 2014 | this review only | not stated | not extracted yet |
| Dal-Fabbro et al. 2014 Mandibular advancement device and CPAP upon cardiovascular parameters in OSA. PMID:24463982 | 2014 | this review only | not stated | not extracted yet |
| De Vries et al. 2019 Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive… PMID:31596213 | 2019 | this review only | not stated | not extracted yet |
| Dissanayake 2021 Obstructive sleep apnea therapy for cardiovascular risk reduction—Time for a rethink? DOI:10.1002/clc.23747 | 2021 | this review only | not stated | not extracted yet |
| Dissanayake et al. 2021 Obstructive sleep apnea therapy for cardiovascular risk reduction-Time for a rethink? PMID:34791676 | 2021 | this review only | not stated | not extracted yet |
| E Silva 2021 The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild… DOI:10.1007/s11325-020-02183-1 | 2021 | this review only | not stated | not extracted yet |
| E. Silva et al. 2021 The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild… PMID:33394328 | 2021 | this review only | not stated | not extracted yet |
| Glos 2016 Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime DOI:10.1007/s11325-015-1265-0 | 2015 | this review only | not stated | not extracted yet |
| Glos et al. 2016 Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. PMID:26463420 | 2016 | this review only | not stated | not extracted yet |
| Guimaraes et al. 2021 The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one… PMID:32964829 | 2021 | this review only | not stated | not extracted yet |
| Lam 2007 Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea DOI:10.1136/thx.2006.063644 | 2007 | this review only | not stated | not extracted yet |
| Lam et al. 2007 Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. PMID:17121868 | 2007 | this review only | not stated | not extracted yet |
| Ou 2024 Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea DOI:10.1016/j.jacc.2024.03.359 | 2024 | this review only | not stated | not extracted yet |
| Ou et al. 2024 Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea. PMID:38588926 | 2024 | this review only | not stated | not extracted yet |
| Phillips 2013 Health Outcomes of Continuous Positive Airway Pressure versus Oral Appliance Treatment for Obstructive Sleep Apnea DOI:10.1164/rccm.201212-2223oc | 2013 | this review only | not stated | not extracted yet |
| Phillips et al. 2013 Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized… PMID:23413266 | 2013 | this review only | not stated | not extracted yet |
| Schutz et al. 2013 Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome. PMID:24037015 | 2013 | this review only | not stated | not extracted yet |
| Uniken Venema 2020 Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study DOI:10.1007/s00784-019-03175-6 | 2019 | this review only | not stated | not extracted yet |
| Uniken Venema et al. 2020 Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study. PMID:31863188 | 2020 | this review only | not stated | not extracted yet |
| Uniken Venema et al. 2022 Cardiovascular and metabolic effects of a mandibular advancement device and continuous positive airway pressure in moderate obstructive… PMID:35088708 | 2022 | this review only | not stated | not extracted yet |
| Yamamoto 2019 Crossover comparison between CPAP and mandibular advancement device with adherence monitor about the effects on endothelial function,… DOI:10.1007/s00380-019-01392-3 | 2019 | this review only | not stated | not extracted yet |
| Yamamoto et al. 2019 Crossover comparison between CPAP and mandibular advancement device with adherence monitor about the effects on endothelial function,… PMID:30927057 | 2019 | this review only | not stated | not extracted yet |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>=18 years) diagnosed with obstructive sleep apnea | Adults with OSA, mostly mild to moderate, age 38 to 61 years, BMI 25.9 to 33.2 kg/m2 (n=1241) |
| Intervention | Mandibular advancement device (MAD) | MAD (14 RCTs) |
| Comparison | Continuous positive airway pressure (CPAP) | CPAP (14 RCTs) |
| Outcomes | Primary: 24-h, awake and asleep blood pressure (mean, systolic, diastolic), dipping, heart rate. Secondary: BMI, waist and neck circumference, LDL, total cholesterol, glucose, HDL, triglycerides, ESS, FOSQ | BP (24-h, awake, asleep, dipping; 3 to 7 trials), heart rate, BMI, waist and neck circumference, LDL, total cholesterol, glucose, HDL, triglycerides, ESS, FOSQ |
| Study designs | Randomised controlled trials only | 14 RCTs (parallel and crossover) from seven countries |
| Timing | Not specified | Treatment 4 weeks to 12 months (one trial 10-year follow-up) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | No | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: No · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |