title: Effects of CPAP and Mandibular Advancement Devices on Health-Related Quality of Life in OSA: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Untreated 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.
  
  
  METHODS
  MEDLINE 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.
  
  
  RESULTS
  Of 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.
  
  
  CONCLUSIONS
  CPAP 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.
authors.affiliation: Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Kuhn
authors.affiliation: Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Esther I
authors.initials: EI
authors.lastname: Schwarz
authors.affiliation: Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bratton
authors.affiliation: Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Valentina A
authors.initials: VA
authors.lastname: Rossi
authors.affiliation: Sleep Disorders Center and Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland. Electronic address: malcolm.kohler@usz.ch.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Kohler
mesh_terms: D045422:Continuous Positive Airway Pressure; D006801:Humans; D019186:Mandibular Advancement; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000628:therapy*
keywords: CPAP; OSA; health-related quality of life; mandibular advancement device; network meta-analysis