Skip to main content

Advertisement

Log in

Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Objective

This study’s objective was to compare the best long-term treatment, mandibular advancement device (MAD) or continuous positive airway pressure (CPAP), for patients with mild obstructive sleep apnea (OSA) in improving excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life.

Methods

This study was a single-blind, parallel, randomized clinical trial with controls. The sample was composed of individuals between 18 and 65 years of age with a body mass index of < 35 kg/m2 and apnea/hypopnea index above five and less than 15. Participants were submitted to physical examination, polysomnography, and the following questionnaires: Pittsburgh Sleep Quality Index, Berlin Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, Karolinska Sleepiness Scale, Modified Fatigue Impact Scale, Functional Outcomes of Sleep Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory. They were also presented with the following tests: maintenance of wakefulness test and psychomotor vigilance task.

Results

Of 79 patients, 25 were in the MAD group, 31 in the CPAP group, and 23 in the control group. Polysomnographic parameters were best normalized with CPAP compared with MAD. Fatigue was improved in the MAD and CPAP groups, with no difference between these treatments. Quality of life was also improved with both treatments, but CPAP was superior to MAD. Daytime sleepiness, mood, and sustained attention showed no difference with the interventions. Greater adherence was obtained with MAD patients than with CPAP measured by hours of use.

Conclusions

Treatment with CPAP was better at normalizing polysomnographic parameters and improving quality of life in patients with mild OSA. Both treatments improved fatigue with no difference between the two treatments. Neither treatment improved daytime sleepiness, mood or sustained attention.

Clinical Trials Database

NTC01461486.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data will be made available on reasonable request.

References

  1. Luz GP, Guimarães TM, Weaver TE et al (2016) Impaired sustained attention and lapses are present in patients with mild obstructive sleep apnea. Sleep Breath 20(2):681–687. https://doi.org/10.1007/s11325-015-1279-7

    Article  PubMed  Google Scholar 

  2. de Godoy LB, Luz GP, Palombini LO et al (2016) Upper airway resistance syndrome patients have worse sleep quality compared to mild obstructive sleep apnea. PLoS ONE 11(5):0156244. https://doi.org/10.1371/journal.pone.0156244

    Article  CAS  Google Scholar 

  3. Oliveira E, Silva L, Guimarães TM, Luz GP et al (2021) The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study. Sleep Breath 25(2):797–805. https://doi.org/10.1007/s11325-020-02183-1

    Article  Google Scholar 

  4. Kushida CA, Morgenthaler TI, Littner MR, American Academy of Sleep et al (2006) Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. Sleep 29(2):240–3. https://doi.org/10.1093/sleep/29.2.240

    Article  PubMed  Google Scholar 

  5. Kushida CA, Nichols DA, Holmes TH et al (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long- term Efficacy Study (APPLES). Sleep 35(12):1593–1602. https://doi.org/10.5665/sleep.2226

    Article  PubMed  PubMed Central  Google Scholar 

  6. Weaver TE, Mancini C, Maislin G et al (2012) Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North American Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med 186(7):677–683. https://doi.org/10.1164/rccm.201202-0200OC

    Article  PubMed  PubMed Central  Google Scholar 

  7. Chowdhuri S, Quan SF, Almeida F, ATS Ad Hoc Committee on Mild Obstructive Sleep Apnea et al (2016) An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults. Am J Respir Crit Care Med 193(9):37–54. https://doi.org/10.1164/rccm.201602-0361ST

    Article  Google Scholar 

  8. American Academy of Sleep Medicine (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research The report of an American Academy of Sleep Medicine Task Force. Sleep 22(5):667–89

    Article  Google Scholar 

  9. American Academy of Sleep Medicine (2005) International classification of sleep disorders, 2nd edn. Diagnostic and coding manual (ICSD-2). American Academy of Sleep Medicine, Westchester

  10. Iber C, Ancoli-Israel S, Chesson AL Jr et al (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. American Academy of Sleep Medicine, Westchester

  11. Bertolazi AN, Fagondes SC, Hoff LS et al (2011) Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med 12(1):70–75

    Article  PubMed  Google Scholar 

  12. Netzer NC, Stoohs RA, Netzer CM et al (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491

    Article  CAS  PubMed  Google Scholar 

  13. Bertolazi AN, Fagondes SC, Hoff LS et al (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35(9):877–883

    Article  PubMed  Google Scholar 

  14. Akerstedt T, Gillberg M (1990) Subjective and objective sleepiness in the active individual. Int J Neurosci 52(1–2):29–37

    Article  CAS  PubMed  Google Scholar 

  15. Hoddes E, Zarcone V, Smythe H et al (1973) Quantification of sleepiness: a new approach. Psychophysiology 10(4):431–436

    Article  CAS  PubMed  Google Scholar 

  16. Pavan K, Schmidt K, Marangoni B et al (2007) Adaptação transcultural e validação da escala modificada de impacto de fadiga. ArqNeuropsiquiatr 65(3-A):669–73

    Google Scholar 

  17. Cunha JA (2001) Manual da versão em português das Escalas Beck. Casa do Psicólogo, São Paulo

    Google Scholar 

  18. Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20(10):835–843

    CAS  PubMed  Google Scholar 

  19. Dinges DF, Powell JW (1985) Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations. Behavior Research 17:652–655

    Google Scholar 

  20. Sullivan S, Kushida C (2008) Multiple sleep latency test and maintenance of wakefulness test. Chest 134:854–861

    Article  PubMed  Google Scholar 

  21. Kushida CA, Chediak A, Berry RB, American Academy of Sleep Medicine. Positive Airway Pressure Titration Task Force et al (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–71

    Article  PubMed  Google Scholar 

  22. Dal-Fabbro C, Chaves-Junior CM, Bittencourt LRA et al (2010) Clinical and polysomnographic assessment of the BRD Appliance in the treatment of Obstructive Sleep Apnea Syndrome. Dental Press J Orthod 15:107–117

    Article  Google Scholar 

  23. Barnes M, McEvoy RD, Banks S et al (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170(6):656–64. https://doi.org/10.1164/rccm.200311-1571OC

    Article  PubMed  Google Scholar 

  24. Marshall NS, Neill AM, Campbell AJ et al (2005) Randomised controlled crossover trial of humidified continuous positive airway pressure in mild obstructive sleep apnoea. Thorax 60(5):427–432. https://doi.org/10.1136/thx.2004.032078

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Marklund M, Carlberg B, Forsgren L et al (2015) Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial. JAMA Intern Med 175(8):1278–1285. https://doi.org/10.1001/jamainternmed.2015.2051

    Article  PubMed  Google Scholar 

  26. Aarab G, Lobbezoo F, Heymans MW et al (2011) Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration 82(2):162–168. https://doi.org/10.1159/000324580

    Article  CAS  PubMed  Google Scholar 

  27. Guimarães TM, Poyares D, Silva LO et al (2021) The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment. J Clin Sleep Med 17(2):149–158. https://doi.org/10.5664/jcsm.8822

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kim H, Thomas RJ, Yun CH et al (2017) Association of mild obstructive sleep apnea with cognitive performance, excessive daytime sleepiness, and quality of life in the general population: The Korean Genome and Epidemiology Study (KoGES). Sleep 40(5). https://doi.org/10.1093/sleep/zsx012

  29. Lee SA, Paek JH, Han SH (2015) Sleep hygiene and its association with daytime sleepiness, depressive symptoms, and quality of life in patients with mild obstructive sleep apnea. J Neurol Sci 359:445–449. https://doi.org/10.1016/j.jns.2015.10.017

    Article  PubMed  Google Scholar 

Download references

Funding

This study was funded by AFIP (Associação Fundo Incentivo à Pesquisa), CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) [Edital Universal do CNPq grant number 476985–20120], Bolsa Produtividade Pesquisa CNPq C1 [grant number 309336/2017–1].

Author information

Authors and Affiliations

Authors

Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Gabriela Costa Pontes Luz, Luciana Badke Neves, Thais de Moura Guimarães, Luciana Oliveira e Silva, Glaury Coelho, Aline Millani, Rodrigo Gomes Alves, and Camila Kase. The first draft of the manuscript was written by Gabriela Costa Pontes Luz, Luciana Badke Neves, and Lia Bittencourt, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lia Bittencourt.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were by the ethical standards of the institutional and national research committee (Ethics approval number 1300/11) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Gabriela Pontes Luz and Luciana Badke are co-first authors of this work.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luz, G.P., Badke, L., Nery, L.E. et al. Effect of CPAP vs. mandibular advancement device for excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life in patients with mild OSA. Sleep Breath 27, 991–1003 (2023). https://doi.org/10.1007/s11325-022-02694-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-022-02694-z

Keywords

Navigation