• Antoine Léotard, Matthieu Lesgoirres, Najeh Daabek, Marius Lebret, Sebastien Bailly, Alain Verain, Fréderic Series, Jean-Louis Pépin, and Jean-Christian Borel.
• HP2, INSERM U1042, University Grenoble Alpes, F-38000, Grenoble, France.
• Sleep Breath. 2019 Sep 1; 23 (3): 885-888.

PurposeEvidence 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.MethodsA 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.ResultsThere was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment.ConclusionsAlthough 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 RegistrationNCT01889472.

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