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Continuous Positive Airway Pressure Compared with Oral Devices or Lifestyle Changes for the Treatment of Obstructive Sleep Apnea: A Review of the Clinical and Cost-effectiveness

Last updated: December 22, 2014
Project Number: RC0619-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of continuous positive airway pressure (CPAP) compared with oral devices for the treatment of sleep apnea?
  2. What is the clinical effectiveness of CPAP compared with lifestyle changes for the treatment of sleep apnea?
  3. What is the cost-effectiveness of CPAP compared with oral devices or lifestyle changes for the treatment of sleep apnea?

Key Message

In general, results from the controlled setting of RCTs and systematic reviews of RCTs found that CPAP lead to better efficacy than oral devices. This benefit may be offset by patient’s higher compliance to oral devices which may result in similar real-life clinical effectiveness. CPAP may be more costly than oral devices or lifestyle advice, and oral devices may be a more cost-effective option in patients who are unable to adhere to CPAP. The small number of trials included in the report, the significant heterogeneity between the included trials for many outcomes, the difference in length of follow-up periods, and the potential difference in costs, treatment effect and adherence of various types of oral appliances caution the interpretation of the results.