December 1, 2023

Are Mandibular Advancement Devices (MADs) as Effective as CPAP for Sleep Apnea?

Are Mandibular Advancement Devices (MADs) as Effective as CPAP for Sleep Apnea?

By Jordan Stern, MD

About the author: Jordan Stern, MD, Founder and CEO of BlueSleep, is a Head and Neck surgeon, a subspecialty of Ear, Nose and Throat (ENT or Otolaryngology), who has treated over 10,000 Sleep Apnea patients and published multiple studies on the diagnosis and treatment of Sleep Apnea. He is also the author of The New York Times bestselling book, Dropping Acid, about reducing acid reflux through a better diet.

Oral Appliances are an Effective First-line Treatment for OSA

At BlueSleep, we love research data on the treatments we’ve recommended to over 10,000 patients. In fact, we now publish our own annual review of Oral Appliances based on efficacy, comfort and maintenance. 

We’re delighted to see that one of our preferred and innovative labs called Prosomnus released a clinical study in August 2023 confirming that “oral appliance therapy (OAT) is effective and non-inferior to CPAP as a first-line treatment for moderate and severe Obstructive Sleep Apnea (OSA).” 

As the premier clinical provider of diagnostic and treatment services for snoring and Sleep Apnea, BlueSleep is on the forefront of offering its patients the best oral appliances and CPAP machines based on real patient experience, industry innovations, and clinical research. For the record, we don’t prescribe over-the-counter treatments like boil & bite mouthguards, tongue extenders, chin straps or tape to keep your mouth shut. They simply don’t work as well, if at all.

BlueSleep Patients have a Choice

BlueSleep patients, in consultation with our Sleep Specialists, have a choice of treatments based on their sleep history; dental history and preferences. Our goal is to get you sleeping better whatever the treatment. In fact 50% of patients receive oral appliances for obstructive sleep apnea and 50% receive CPAP.

Before 1981, the primary treatment for OSA was a tracheotomy, a surgical procedure to create a hole in the patient’s windpipe. The first successful non-invasive treatment for OSA was CPAP, meaning continuous positive airway pressure. For years CPAP has been the first-line therapy for OSA, and mandibular advancement devices were a second-line option in patients unable to use CPAP or those with mild OSA. But, times have changed.

Oral Appliances are Effective for Moderate and Severe Sleep Apnea Too

The Prosomnus research and other studies, including our own peer reviewed studies, show that oral devices are effective for moderate and severe Sleep Apnea too. These patients can now be mask-free and tube-free while getting an effective treatment for Sleep Apnea, a debilitating problem that leads to hypertension, stroke, diabetes, and daytime sleepiness. 

The data presented at the ProSleep 2023 Users Conference showed that 136 patients with moderate and severe obstructive sleep apnea using the Prosomnus EVO Device was:

  • Effective among 90% of moderate and 85% of severe OSA patients.
  • Preferred by patients, with 98% continuing therapy at three months versus 22% discontinuing CPAP therapy over the same period of time.

BlueSleep’s Own Research Proves that Oral Devices are Effective

In 2021 BlueSleep published the EFFECTS study which evaluated efficacy and effectiveness of oral appliance therapy and compliance of treatment with embedded compliance trackers.  We also found that oral appliance therapy was effective for mild moderate and severe sleep apnea. Currently, we’re evaluating effectiveness of oral appliance therapy in a large scale prospective involving thousands of BlueSleep patients.

Get an Action Plan for Sleep Apnea

If you’re suffering from daytime sleepiness, snoring, and chronic fatigue, then we recommend the following:

  • Make an appointment with a Sleep Specialist.
  • Take a Home Sleep Test to measure Sleep Apnea.
  • Get a Mandibular Advancement Device (MAD) or CPAP to reduce snoring and prevent Sleep Apnea.
  • Take another Home Sleep Test three months after the MAD treatment.
  • If you’re overweight, first consider a diet and exercise program.
  • Follow-up with your doctor every 12 months to monitor your sleep health.


Efficacy and effectiveness of the ProSomnus® [IA] sleep device for the treatment of obstructive sleep apnea: Effects Study

MAD should be considered an effective first-line treatment for patients with mild and moderate sleep apnea and for severe sleep apnea for patients who prefer, refuse, or are not candidates for CPAP.

Efficacy of custom made oral appliance for treatment of obstructive sleep apnea

Oral appliance for the treatment of OSA is considered as an effective, low-risk alternative to CPAP. Demand for oral appliances increases as an alternative for those who cannot tolerate CPAP and refuse surgery. Oral appliances uses the traditional methods to advance the mandible thus modify the posture and thereby enlarge the airway or otherwise reduce the collapsibility.

The role of oral appliance therapy in obstructive sleep apnea

The importance of understanding the role and use of oral appliance therapy (OAT) as an acceptable alternative should be a key part of our multidisciplinary care pathway. OAT is a noninvasive treatment for mild–moderate OSA and reduces apnoeas/hypopnoeas by enlarging the cross-sectional upper airway dimension via anterior displacement of the mandible and the attached tongue, resulting in improved upper airway patency 

Oral appliance effectiveness and patient satisfaction with obstructive sleep apnea treatment in adults

Oral appliances complement positive-pressure treatment and do not interfere with it in any way. Craniometric parameters seem to be applicable as predictors of success or failure of appliance treatment.

In contrast to CPAP, patients may consider as advantages of the appliance its easy portability without the need for power supply, its low cost, and the likely favorable opinion of their partner who does not get disturbed at night. In the initial phase of treatment with OA, the patient must get used to possible adverse effects, which may include excessive salivation or, to the contrary, dry mouth, hurting teeth, or temporomandibular joint pain. Reported adverse event frequencies vary widely, which may be potentially due to differences between the appliances used. The adverse events are, however, usually temporary and typically subside during the first 2 months of use [8,15]. Patients of our set reported only minimal adverse events (several of them reported a manageable pressure on teeth), which may be attributable to the individually manufactured oral appliance and thorough patient education regarding its use.

Oral appliance therapy for obstructive sleep apnea: State of the Art

There is evidence that at least the short-term health outcomes of OA and PAP are similar, despite mild residual sleep apnoea with OA treatment. Although PAP is highly efficacious, adherence to it outside of the sleep laboratory is often suboptimal. Treatment effectiveness, in terms of health benefits, is a composite of efficacy and adherence. OA and PAP have different profiles of efficacy and adherence. However, the end result in terms of treatment effectiveness may be the same.

Oral appliances are the main alternative to PAP for the treatment of OSA. There has been an expansion of the research evidence supporting the use of oral appliances in clinical practice, and key professional bodies now recommend oral appliances for use in patients with OSA who are intolerant to PAP therapy or prefer an alternative therapy. Patient preference is a key component of patient-centered care and has a pivotal role in treatment acceptance, usage, and health outcomes.

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