title: Alternatives to continuous positive airway pressure 2: mandibular advancement devices compared.
abstract: OBJECTIVE
  Although mandibular advancement devices (MADs) provide an alternative to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea (OSA), their effectiveness and role remain unclear. Several recent studies and an updated meta-analysis have attempted to address these uncertainties. This review examines their contribution to the existing evidence and discusses the future priorities for MAD research.
  
  
  RESULTS
  Recent work has examined the impact of MAD design on clinical and cost-effectiveness in milder disease. A robust comparison of CPAP and MADs in more severe OSA has reported equivalent improvements in several important health outcomes. Other notable contributions have examined compliance, definitions of treatment success and longer term outcomes of MAD therapy.
  
  
  CONCLUSIONS
  There is now a growing body of evidence suggesting that MADs are a clinically and cost-effective treatment for OSA; and in some cases, patient preference may make them a better option than CPAP. Further work needs to continue to refine MAD therapy in order to optimize treatment response and compliance, whilst retaining a pragmatic and cost-effective approach that is relevant to clinical practice and sustainable in the longer term.
authors.affiliation: Respiratory Support and Sleep Centre (RSSC), Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Quinnell
authors.forename: Abigail L
authors.initials: AL
authors.lastname: Clutterbuck-James
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D006801:Humans; D019186:Mandibular Advancement / Q000295:instrumentation; D009968:Orthodontic Appliances, Removable; D010349:Patient Compliance; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome