ArticlePloS one2017
Combining MAD and CPAP as an effective strategy for treating patients with severe sleep apnea intolerant to high-pressure PAP and unresponsive to MAD.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Maximizing outcomes by multimodal treatment in obstructive sleep apnea: a systematic review and meta-analysis.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026Pooled it
- Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial.Sleep & breathing = Schlaf & Atmung · 2019Trial
- Article
- Response to Hypoglossal Nerve Stimulation Changes With Body Mass Index and Supine Sleep.JAMA otolaryngology-- head & neck surgery · 2024Article
- The Present and Future of the Clinical Use of Physiological Traits for the Treatment of Patients with OSA: A Narrative Review.Journal of clinical medicine · 2024Review
- Article
- Personalized multimodal management for severe obstructive sleep apnea in a patient intolerant of positive airway pressure with hypoglossal nerve stimulator and mandibular advancement device.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2023Article
- Current and novel treatment options for obstructive sleep apnoea.ERJ open research · 2022Review
- Prediction of Mandibular Advancement Device Response Using CPAP Pressure in Different Polysomnographic Phenotypes.Nature and science of sleep · 2022Article
- A comprehensive review of respiratory, autonomic and cardiovascular responses to intermittent hypoxia in humans.Experimental neurology · 2021Review
- Mandibular Advancement Devices for OSA: An Alternative to CPAP?Pulmonary therapy · 2021Review
- Support vector machine prediction of obstructive sleep apnea in a large-scale Chinese clinical sample.Sleep · 2020Article
- Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art.Journal of clinical medicine · 2019Review
- Strategies in the clinical diagnosis and surgical treatment of OSAHS with multilevel obstruction.The Journal of international medical research · 2019Article
- The role of drug-induced sleep endoscopy: predicting and guiding upper airway surgery for adult OSA patients.Sleep & breathing = Schlaf & Atmung · 2018Article
- Article
Corrections and comments
- Erratum issued
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThis study aimed to determine the effect of combining positive airway pressure (PAP) therapy and mandibular advancement device (MAD) in patients with severe obstructive sleep apnea (OSA) who were pressure intolerant for PAP and were unresponsive to MAD.
methodsThis retrospective study reviewed the medical records of severe OSA patients with apnea-hypopnea index (AHI) ≥ 30/hr who were diagnosed between October 1, 2008 and June 30, 2014. Patients were initially treated with 2 weeks of PAP, and those who were intolerant to high-pressure PAP (≥15 cm H2O) were switched to 12 weeks of MAD, which is a monobloc designed at 75% of maximum protrusion. Patients who had high residual AHI (≥15/hr) on MAD underwent 12 weeks of combination therapy (CT) with MAD and CPAP and were enrolled in the present study. Enrolled subjects who completed the 12-week CT were followed-up until June 30, 2016.
resultsA total of 14 male patients were included. All three treatments effectively reduced AHI, oxygen desaturation index (ODI), and total sleep time with SpO2 <90% (% TST-SpO2<90%) compared to pretreatment values. The residual AHI and ODI on CT was lower than that on MAD or PAP. The residual % TST-SpO2<90% was lower than that on MAD and similar to that on PAP. The therapeutic pressure on CT was on average 9.2 cm H2O lower than that on PAP. For the 11 patients who completed CT, only CT reduced ESS compared to pretreatment value. No treatment had significant impact on % slow wave sleep or overnight change of blood pressure. For patients who completed CT, the average usage was 5.9±1.7 hr/night at 12th week and 6.4±1.5 hr/night at a median follow-up of 36.5-months.
conclusionsCombining MAD and CPAP showed additive effects on reducing AHI and ODI, and lowered the therapeutic pressures.
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