Evidence map›Paper›PMID 31596213›Full record

Trial reportJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine2019

Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea.

Grietje E de Vries, Aarnoud Hoekema, Karin M Vermeulen, Johannes Q P J Claessen, Wouter Jacobs, Jan van der Maten, Johannes H van der Hoeven, Boudewijn Stegenga, Huib A M Kerstjens, Peter J Wijkstra

2 registry-linked trialsAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2019. 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 19 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 7 pooled it
–field-weighted citation impact
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.

NCT01588275 nacompletednot on this map

Cost-effectiveness of obstRuctivE Sleep Apnea Therapy (REST Study): Comparison of MRA Therapy Versus CPAP Therapy in Moderate OSAS

TypeinterventionalSponsorUniversity Medical Center GroningenRan2012 to 2017Enrolled86ConditionsSleep Apnea, ObstructiveArmsmandibular repositioning appliance (MRA) (SomnoDent), Continuous positive airway pressure (CPAP)
NCT07074288 narecruitingnot on this mapstarted 2025, after this paper: background citation

Obstructive Sleep Apnea Non-PAP Outcomes and Viable Alternatives (OSANOVA): Comparison of Mandibular Advancement Device and Hypoglossal Nerve Stimulation Outcomes

TypeinterventionalSponsorWashington University School of MedicineRan2025 to 2027Enrolled60ConditionsObstructive Sleep ApneaArmsMAD, HGNS
3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 7 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Large variability in definitions of sleep apnea indices used in clinical studies.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2024
    Pooled it
  6. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea.European respiratory review : an official journal of the European Respiratory Society · 2021
    Guideline
  7. Pooled it
  8. Trial
  9. Trial
  10. 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
    Trial
  11. Redefining Obstructive Sleep Apnea: Treatment in the Modern Era.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026
    Review
  12. Article
  13. Article
  14. Article
  15. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Grietje E de VriesDepartment of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, The Netherlands.
Aarnoud HoekemaDepartment of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
Karin M VermeulenDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands.
Johannes Q P J ClaessenDepartment of Ear Nose and Throat surgery, Martini Hospital Groningen, The Netherlands.
Wouter JacobsDepartment of Pulmonary Diseases, Martini Hospital Groningen, The Netherlands.
Jan van der MatenDepartment of Pulmonary Diseases, Medical Center Leeuwarden, The Netherlands.
Johannes H van der HoevenDepartment of Clinical Neurophysiology, University of Groningen, University Medical Center Groningen, The Netherlands.
Boudewijn StegengaDepartment of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
Huib A M KerstjensDepartment of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, The Netherlands.
Peter J WijkstraDepartment of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

objectivesLimited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA.

methodsIn a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective.

resultsIn the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8-22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5-18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference €2.156). MAD was less cost-effective than CPAP after 12 months (ICER -€305 [-€3.003 to €1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (€33.701 [-€191.106 to €562.271] per QALY gained).

conclusionsCPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. CLINICAL

trial registrationRegistry: ClinicalTrials.gov; Identifier: NCT01588275.

Indexed as

Continuous Positive Airway PressureCost-Benefit AnalysisFemaleHumansMaleMandibular AdvancementMiddle AgedPatient CompliancePolysomnographyQuality of LifeSleep Apnea, ObstructiveTreatment Outcomecosts and cost analysisrandomized controlled trialsleep apnea

Identifiers

PMID31596213
PMCPMC6778341

What OpenQuestion holds

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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.