Patients with sleep apnea who are tired during the day because they can't wear a breathing mask all night to keep their airways open may be able to reduce daytime sleepiness by using a jaw support instead, a research review suggests.
Millions of patients worldwide wear breathing masks all night to ease sleep apnea, a common disorder that leads to disrupted breathing or shallow breaths during sleep.
The masks are connected to a machine that provides continuous positive airway pressure (CPAP), which splints the airway open with an airstream so the upper airway can't collapse during sleep.
Even though CPAP is safe and effective and often doctors' first choice, some patients can't tolerate wearing the masks all night long. For these people, doctors may offer an alternative known as mandibular advancement devices (MAD), which open up space in the airway by pushing out the lower jaw bone to make it less likely that the upper airway collapses during sleep.
Researchers analysed data from 67 studies with almost 6,900 patients and found patients had a greater reduction in daytime sleepiness with CPAP than with MAD.
But both options were effective enough that the choice of device might be left up to patients' preferences, said senior study author Dr. Malcolm Kohler, chair of respiratory medicine at the University Hospital of Zurich in Switzerland.
"Most doctors still consider CPAP as first-line treatment for patients with obstructive sleep apnea," Kohler said by email. "If a patient cannot really use CPAP adequately e.g. only two to three hours per night, but does fine with a MAD which he can tolerate for seven hours a night, then he should be treated with a MAD."
Kohler and colleagues reviewed previous research on the two treatments for patients with sleep apnea to see how they compared in reducing sleepiness based on a standard 0 to 24 point scale known as the Epworth Sleepiness Scale (ESS).
Higher scores indicate greater degrees of daytime sleepiness based on questions that focus on how often people doze off during different daytime situations and activities.
People in the study who got CPAP had typical ESS scores that were 2.5 points lower than people in control groups who didn't receive treatment, the analysis found.
By comparison, people in the study who got MAD had average ESS scores 1.7 points lower than control groups.
The findings confirm that both CPAP and MAD reduce daytime sleepiness, and the analysis also reinforces that MAD is a good alternative for patients who can't tolerate CPAP, said Dr. Ferran Barbe, who wrote an editorial accompanying the study with colleague Manual Sanchez-de-la-Torre of the respiratory department at the Hospital Universitari Arnau de Vilanova and Santa Maria in Lleida, Spain.
"There are lots of studies focused on CPAP effects and less evidence with MAD," Barbe said by email. "However, in clinical practice MAD also works. The take-home is that we have two good treatments for obstructive sleep apnea."