title: Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis.
abstract: To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA).
  
  
  
  Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception - September 8, 2015).
  
  
  
  Individuals with OSA.
  
  
  
  CPAP, MADs, exercise training, and dietary weight loss.
  
  
  
  CPAP decreased apnea-hypopnea index (AHI) the most [by 25.27 events/hour (22.03-28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [-8.04 (-17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [-10.06 (-14.21 to -5.91) and -7.82 (-13.04 to -2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68-5.48)], albeit with a non-significant difference compared to MADs and CPAP.
  
  
  
  CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two.
authors.affiliation: Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University, Atlanta, GA, USA. Electronic address: Imran.Hasan.Iftikhar@emory.edu.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Iftikhar
authors.affiliation: Departmento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Lia
authors.initials: L
authors.lastname: Bittencourt
authors.affiliation: College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Youngstedt
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.affiliation: Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Cistulli
authors.affiliation: Department of Medicine, Division of Sleep Medicine, Pulmonary, Allergy and Critical Care, University of Pennsylvania Medical Center, Philadelphia, PA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Schwab
authors.affiliation: Department of Clinical Research, Palmetto Health Richland, Columbia, SC, USA.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Durkin
authors.affiliation: Division of Pulmonary, Allergy, Critical care & Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
authors.forename: Ulysses J
authors.initials: UJ
authors.lastname: Magalang
mesh_terms: D000328:Adult; D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D004035:Diet Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D015431:Weight Loss
keywords: Aerobic exercise training; Continuous positive airway pressure; Dietary weight loss; Mandibular advancement device; Network meta-analysis