• Eric Kuhn, Esther I Schwarz, Daniel J Bratton, Valentina A Rossi, and Malcolm Kohler.
• Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
• Chest. 2017 Apr 1; 151 (4): 786-794.

BackgroundUntreated OSA is associated with impaired health-related quality of life (QoL) and excessive daytime sleepiness, which have been shown to improve with treatment. The aim was to compare the effects of CPAP and a mandibular advancement device (MAD) on health-related QoL in OSA.MethodsMEDLINE and the Cochrane Library were searched up to November 2015 for randomized controlled trials (RCTs) comparing the effect of CPAP, MADs, or an inactive control treatment on health-related QoL assessed by the 36-Item Short Form Health Survey (SF-36) in OSA. Extraction of study characteristics, quality, and bias assessment were independently performed by three authors. A network meta-analysis using multivariate random-effects meta-regression was performed to assess treatment effects on the mental component score (MCS) and the physical component score (PCS) of the SF-36.ResultsOf 1,491 identified studies, 23 RCTs were included in the meta-analysis (2,342 patients). Compared with an inactive control, CPAP was associated with a 1.7 point (95% CI, 0.1-3.2; P = .036) improvement in the MCS and a 1.7 point (95% CI, 0.5-2.9; P = .005) improvement in the PCS. MADs were associated with a 2.4 point (95% CI, 0.0-4.9; P = .053) and a 1.5 point (95% CI, -0.2 to 3.2; P = .076) improvement in the MCS and PCS, respectively, compared with inactive control treatments. There were no statistically significant differences between treatment effects of CPAP and MAD on the SF-36 scores.ConclusionsCPAP is effective in improving health-related QoL in OSA, and MADs may be just as effective, but further RCTs comparing the two treatments are required.Copyright © 2017 American College of Chest Physicians. All rights reserved.

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