title: Mandibular Advancement Device as a Comparable Treatment to Nasal Continuous Positive Airway Pressure for Positional Obstructive Sleep Apnea.
abstract: Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients.
  
  
  
  Among patients diagnosed with OSA at a single sleep center from January 2008 to May 2014, male subjects with moderate OSA were recruited and stringently categorized as having P-OSA when the ratio of their lateral apnea-hypopnea index (AHI) to supine AHI was ≤ 0.5, their lateral sleep time was > 60 minutes, and their lateral REM sleep time was longer than 10 minutes. Treatment efficacy was compared between P-OSA subjects with an MAD (n = 34) and those with nCPAP (n = 34) after matching for age, body-mass index, and baseline AHI.
  
  
  
  There were no significant differences in baseline AHI (MAD: nCPAP = 20.6 ± 3.9/h: 21.3 ± 1.7/h, p = 0.35) or in follow-up AHI (MAD: nCPAP = 4.7 ± 3.5/h: 3.4 ± 3.7/h, p = 0.12) between the 2 treatment groups, and hence MADs lowered the AHI to the same extent as nCPAP.
  
  
  
  These findings suggest that an MAD is as efficacious as nCPAP for P-OSA patients. MAD treatment for this specific phenotype may be a promising patient-tailored and first-line approach to OSA.
  
  
  
  A commentary on this article appears in this issue on page 1079.
authors.affiliation: Department of Psychiatry, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Takaesu
authors.affiliation: Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.|Foundation of Sleep and Health Sciences, Tokyo, Japan.|Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuiki
authors.affiliation: Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.|Foundation of Sleep and Health Sciences, Tokyo, Japan.
authors.forename: Mina
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.|Department of Somnology, Tokyo Medical University, Tokyo, Japan.|Foundation of Sleep and Health Sciences, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Komada
authors.affiliation: Department of Respiratory Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan.|Department of Somnology, Tokyo Medical University, Tokyo, Japan.|Foundation of Sleep and Health Sciences, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Inoue
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011187:Posture; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
keywords: mandibular advancement device; nasal continuous positive airway pressure; oral appliance; positional obstructive sleep apnea