Evidence map›Paper›PMID 29129030›Full record

SynthesisSleep & breathing = Schlaf & Atmung2018

Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis.

Martha Schwartz, Luis Acosta, Yuan-Lung Hung, Mariela Padilla, Reyes Enciso

2 registry-linked trialsAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Sleep & breathing = Schlaf & Atmung, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 87 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
87citing papers in PubMed, 9 pooled it
9.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

NCT03517150 naunknown statusnot on this map

Efficiency of Intraoral Appliance in the Treatment of Obstructive Sleep Apnea Syndrome in Obese Class III

TypeinterventionalSponsorUniversity of Sao PauloRan2016 to 2018Enrolled60ConditionsObstructive Sleep Apnea, ObesityArmsmandibular advancement device
NCT07679282 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Comparative Effectiveness of Positive Airway Pressure Therapy, Dental Device, and Atomoxetine-Oxybutynin for Sleep Apnea: the ADAPT-OSA Study

TypeinterventionalSponsorSairam ParthasarathyRan2026 to 2032Enrolled2,400ConditionsObstructive Sleep Apnea (OSA)ArmsPositive airway pressure (PAP) therapy, Sleep dental device, Atomoxetine-oxybutynin
3 · Its place in the literature

Who cites it

87 citing papers in PubMed, 9 syntheses or guidelines pooled it, 192 citations in OpenAlex.

  1. Pooled it
  2. Efficacy of advancement treatments of the stomatognathic system on objective sleepiness in OSA: a systematic review.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025
    Pooled it
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  8. Factors influencing adherence to oral appliance therapy in adults with obstructive sleep apnea: a systematic review and meta-analysis.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2021
    Pooled it
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  15. The efficacy of a titrated tongue-stabilizing device on obstructive sleep apnea: a quasi-experimental study.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2021
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  18. Long-Term Objective Adherence to Mandibular Advancement Device Therapy Versus Continuous Positive Airway Pressure in Patients With Moderate Obstructive Sleep Apnea.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2019
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  19. Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2019
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  20. Review

27 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Martha SchwartzMaster of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, 925 West 34th St, Los Angeles, CA, USA.
Luis AcostaMaster of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, 925 West 34th St, Los Angeles, CA, USA.
Yuan-Lung HungMaster of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of USC, 925 West 34th St, Los Angeles, CA, USA.
Mariela PadillaDivision of Periodontology, Diagnostic Sciences and Dental Hygiene, Herman Ostrow School of Dentistry of USC, Los Angeles, CA, USA.
Reyes EncisoDivision of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California, 925 West 34th Street, room #4268, Los Angeles, CA, 90089, USA. renciso@usc.edu.ORCID http://orcid.org/0000-0003-1751-3286
University of Southern California · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias. Initial search yielded 240 unduplicated references, which the authors reduced to 12 relevant studies. Patients with CPAP therapy showed no statistically significant difference in the post-treatment quality of life measured with the SF-36 mental health component (p = .994), or the SF-36 physical functioning component (p = .827). There was no significant improvement in neither Functional Outcomes of Sleep Questionnaire (p = .788) nor cognitive performance (p = .395) compared to patients treated with oral appliances. However, the meta-analyses' overall results showed a significant improvement in the post-treatment apnea-hypopnea index (AHI) in favor of CPAP therapy as compared with the oral appliance group (p < .001). Meta-analyses showed unclear results for sleepiness with no significant differences in average post-treatment Epworth Sleepiness Scale [ESS] (p = .203), but significant differences in change in ESS from baseline favorable to CPAP treatment (p = .047). Further studies are needed. Compliance with treatment was 1.1 h per night significantly lower with CPAP than MAD (p = .004), which could explain why though efficacy (AHI) is better with CPAP, no significant results are shown for quality of life, cognitive, and functional outcomes. Though CPAP is significantly more efficient in reducing AHI (moderate quality of evidence), it has a significantly lower compliance resulting in no differences with MAD in quality of life, cognitive, or functional outcomes. Sleep medicine professionals should monitor treatment compliance and offer patients non-compliant with CPAP an oral appliance for treatment of OSA.

Indexed as

Continuous Positive Airway PressureMandibular AdvancementHumansPatient ComplianceQuality of LifeSleep Apnea, ObstructiveApnea–hypopnea indexContinuous positive airway pressureFunctional outcomesMandibular advancement deviceObstructive sleep apneaQuality of life

Identifiers

PMID29129030
OpenAlexW2767572430

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.