Long-term objective compliance with a mandibular advancement device and continuous positive airway pressure in moderate obstructive sleep apnea

Background: Comparable effectiveness of mandibular advancement device (MAD) with continuous positive airway pressure (CPAP) therapy has been attributed to a higher compliance with MAD when compared with CPAP. However, a direct comparison of objective compliance of MAD and CPAP has not yet been performed. The aim of this study was to assess the long-term objective and subjective compliance of MAD versus CPAP in patients with moderate obstructive sleep apnea. Methods: Compliance was monitored for 12 months in 59 patients with apnea-hypopnea index 15-30 events/h as part of a randomized controlled trial. Objective compliance was assessed using a microsensor in the MAD and the built-in SD-card in CPAP. Subjective compliance with both therapies was assessed using a questionnaire. Results: Four (17%) patients crossed over from MAD to CPAP, and seven (22%) patients from CPAP to MAD. Forty patients (68%) completed the study with the therapy to which they were randomly assigned. Median (IQR) objective compliance (h/night) in the 3rd month was 7.4 (5.2–8.2) for MAD and 6.8 (5.7–7.6) for CPAP (p=0.41), compared to 6.9 (3.5–7.9) with MAD and 6.8 (5.2–7.6) with CPAP (p=0.85) in the 12th month. There were no significant changes between the 3rd and 12th month for both MAD (p=0.21) and CPAP (p=0.46) and changes were not significantly different between MAD and CPAP (p=0.51). Subjective compliance was significantly higher with MAD than CPAP at all follow-up moments. Subjective CPAP compliance was lower than objective CPAP compliance at the 6th and 12th month (p=0.02). Conclusion: Objective compliance with MAD and CPAP was comparable and consistent over time.