Abstract
In obstructive sleep apnea syndrome (OSAS) continuous positive airway pressure (CPAP) is considered in most guidelines as the reference treatment for OSAS, and mandibular repositioning appliance (MRA) as alternative therapy in patients with CPAP-failure. The Dutch OSAS guideline of 2009 states that, CPAP is the preferred treatment in severe (AHI >30) OSAS but MRA and CPAP have the same efficacy in moderate (AHI 15-30) OSAS. This statement has, however, never been evaluated in clinical practice.
This study is a retrospective observational non-inferiority study. The 1-year treatment success (AHI < 10) of CPAP and MRA for moderate OSAS has been compared. Due to the non-random assignment of the treatments and the associated differences in patient characteristics, treatment effects are corrected with a propensity score. The non-inferiority margin was defined at 25% difference in treatment success rates, with an estimated success rate of 80% for CPAP, which is conform to an odds ratio of 3.27.
In 2011 31 MRA and 123 CPAP treatments where started in patients with moderate OSAS in our Dutch hospital. The OR of treatment success of CPAP versus MRA is 0.45 with a 95% CI of 0.137 to 1.45. Since this upper limit is below the inferiority threshold of 3.27, MRA is non-inferior to CPAP.
The 1-year efficacy of MRA is non-inferior to CPAP therapy in patients with moderate OSAS. The recommendation in the Dutch National OSAS guideline, to choose between MRA and CPAP in moderate OSAS, seems to be valid.
- © 2014 ERS
