For years, CPAP has been considered the gold standard of treatment for sleep apnea. It’s essentially 100% effective: people using CPAP properly don’t have apneic episodes. However, there have also been doubts about whether this theoretical effectiveness translated to the best results for patients.
Now we know that oral appliances deliver results that are just as good as CPAP, a conclusion that’s reinforced by the results of a new study showing that in terms of practical outcomes, the two treatments are equivalent.
A Good Review
This study is actually a review of randomized, placebo-controlled clinical trials of the two treatments for sleep apnea. This type of clinical trial is considered the best way to determine whether a treatment is effective against a condition. Researchers identified 240 potential trials for inclusion in their review, but only 12 met their criteria. However, this number of studies still allowed for a high degree of certainty, and the rigorous exclusion criteria helped ensure that the comparisons made are actually informative and accurate.
Where CPAP Was Better
The studies illuminated the differences between the two treatments. One of the most significant differences was in the reduction of the apnea-hypopnea index (AHI). CPAP was much better at reducing the AHI than oral appliances. Since AHI is the technical measure used to benchmark the severity of sleep apnea, this is what is commonly used to show that CPAP is the “better”: sleep apnea treatment. CPAP was also more effective at reducing patients’ ratings on the Epworth Sleepiness Scale (ESS), although there was no significant difference between the final ESS for patients using CPAP and those using oral appliances.
Where Oral Appliances Were Better
Oral appliances didn’t reduce AHI as much as CPAP, it’s true, but people using oral appliances had significant better compliance. On average, people used their oral appliances for 1.1 hours more every night, a 40% increase over the average nightly use for CPAP patients who were compliant.
Functional Outcomes Equivalent
With the one treatment giving better effectiveness and the other treatment giving better compliance, it’s not a surprise that the two treatments should be relatively equal in terms of functional outcomes.
The impact of treatments in these studies was measured using the Functional Outcomes of Sleep Questionnaire. Patients using both treatments showed statistically indistinguishable results. And the cognitive improvement of both groups was also equivalent.
Researchers looking at this data recommended that once patients are prescribed CPAP, they should be closely monitored. If they are not compliant with their treatment, they should be moved to oral appliances instead.
Don’t Stick with a Failing Treatment
If your doctor thinks that CPAP is the best treatment for your sleep apnea, you should give it a fair try. But if you can’t make it work or aren’t happy with the treatment, there’s no reason why you should stick with it. Instead, you should shift to using an oral appliance.
With similar treatment outcomes, it’s best to get a treatment that you will actually use, not one that you won’t.