Comparative efficacy of CPAP, MADs, exercise-training and dietary weight loss for sleep apnea: a network meta-analysis.

Publication date: Available online 28 June 2016
Source:Sleep Medicine
Author(s): Imran H. Iftikhar, Lia Bittencourt, Shawn D. Youngstedt, Najib Ayas, Peter Cistulli, Richard Schwab, Martin W. Durkin, Ulysses J. Magalang
Study objectiveTo 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).DesignNetwork meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception - September 8^th, 2015).PatientsIndividuals with OSA.InterventionsCPAP, MADs, exercise training and dietary weight loss.ResultsCPAP decreased apnea hypopnea index (AHI) the most [by 25.27 events/hour (22.03 to 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 to 5.48)], albeit with a non-significant difference compared to MADs and CPAP.ConclusionsCPAP 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.



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