Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial



Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month’s use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask.


A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask.


There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment.


Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort.

Trial registration


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We would like to acknowledged Johanna Robertson (PT, PhD) for language editing.

Author information




Conception: J-C Borel, F Series; acquisition: M Lesgoirres, A Verain; data analysis: N Daabek, S Bailly; data interpretation: J-C Borel, M Lebret, A Léotard; drafting the work or revising it: A Léotard, J-C Borel, JL Pépin, M Lebret, F Series; agreeing with manuscript results and conclusions: all authors

Corresponding author

Correspondence to Marius Lebret.

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Conflict of interest

The authors M Lebret, M Lesgoirres, N Daabek, and J-C Borel are employees of AGIR à dom., a non-profit homecare provider. J-C Borel has received grants, personal fees, and non-financial support from Philips Healthcare and ResMed unrelated to the submitted work. M Lebret has received personal fees and non-financial support from Air liquid Medical System and Sefam unrelated to the submitted work. A Léotard, S Bailly, A Verain, F Series, and J-L Pépin declared that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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apnea–hypopnea index


body mass index


continuous positive airway pressure


excessive daytime sleepiness


mandibular advancement device


nasal mask


nasal mask with associated mandibular advancement device


oronasal mask


obstructive sleep apnea syndrome


quality of life

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Léotard, A., Lesgoirres, M., Daabek, N. et al. Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial. Sleep Breath 23, 885–888 (2019).

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  • Continuous positive airway pressure
  • Nasal mask
  • Mandibular advancement device
  • Treatment adherence and compliance
  • Obstructive sleep apnea