Mandibular advancement devices (MAD) provide comparable cardiovascular benefits to CPAP for obstructive sleep apnea patients, with significantly better adherence and greater daytime blood pressure reduction, though CPAP remains superior for reducing apnea-hypopnea events.
- MAD reduced daytime systolic blood pressure 1.99 mmHg more than CPAP
- Patients used MAD 0.71 hours longer per night than CPAP
- CPAP reduced apnea-hypopnea events more effectively than MAD
How this compares to prior research
CPAP has long been considered the gold standard treatment for obstructive sleep apnea, but its real-world effectiveness is limited by poor patient adherence. Previous research established CPAP\’s superiority in reducing breathing interruptions during sleep, but questions remained about whether alternative treatments could provide comparable cardiovascular benefits. This meta-analysis addresses whether mandibular advancement devices, which are generally better tolerated, can match CPAP\’s cardiovascular protective effects despite being less effective at reducing apnea events.
Sleep apnea treatment prevalence trends, global data, 1980–1989
Key findings
- MAD achieved significantly greater reduction in daytime systolic blood pressure compared with CPAP (1.99 mmHg difference)
- MAD demonstrated significantly longer nightly adherence than CPAP (0.71 hours per night more)
- CPAP showed superior efficacy in reducing apnea-hypopnea index by 8.45 events per hour compared to MAD
What this means in practice
- Ask your doctor about mandibular advancement devices if you struggle with CPAP adherence or tolerance
- Consider that better nightly adherence with MAD may offset its lower physiological efficacy for some patients
- If cardiovascular risk is your primary concern, know that MAD provides comparable blood pressure benefits to CPAP
Frequently asked questions
Are mandibular advancement devices as effective as CPAP for sleep apnea?
MAD provides comparable cardiovascular benefits and better adherence than CPAP, but CPAP is more effective at reducing breathing interruptions during sleep. Both improve daytime sleepiness equally.
How much better is patient compliance with MAD versus CPAP?
Patients used MAD an average of 0.71 hours longer per night than CPAP, representing significantly better objective adherence based on pooled tracking data from multiple studies.
Should I consider MAD if I can't tolerate CPAP?
Yes. For patients who cannot tolerate CPAP, MAD serves as a viable alternative for cardiovascular risk management, offering comparable blood pressure benefits with better adherence.
Key terms explained
Apnea-hypopnea index (AHI)
Number of times per hour breathing stops or becomes shallow during sleep, measuring sleep apnea severity
Mandibular advancement device (MAD)
Oral appliance that holds the lower jaw forward during sleep to keep airways open
Continuous positive airway pressure (CPAP)
Machine that delivers pressurized air through a mask to keep airways open during sleep
Source: Effects of mandibular advancement devices vs. CPAP on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials. · DOI: doi: 10.3389/fneur.2026.1846726