Anti-snoring appliance expert and creator of the Mandibular Snoring Inhibitor (MSi) Phil Chapman shares his thoughts on newly released literature comparing continuous positive airway pressure machines (CPAP) and Mandibular Advancement Splint therapy.

As an avid follower of all things Obstructive Sleep Apnoea (OSA), I was thrilled to discover that a newly published book, Dental Sleep Medicine - A clinical guide, was now available in the UK. One passage that immediately drew my attention was Dr H K Chaing’s review of the recent meta-analysis, examination comparing Continuous positive airway pressure machines (CPAP) and Mandibular Advancement Splint (MAS) therapy.

What are the pros and cons of CPAP machines?

For as long as I can remember, CPAP has always seemed to have been advocated as the ‘gold standard’, for OSA treatment. However, the latest evidence seems to indicate otherwise. Although, certainly effective, the concern with CPAP is the amount of partial or non-compliance that this treatment encounters due to discomfort.

At best, discomfort that is difficult to tolerate risks a reduction of compliance, but it can also lead to complete non-use. This is where CPAP does seem to struggle when compared to MAS treatment, even though CPAP efficacy is unquestionably above that of the MAS. 

This finding was made possible by combining the compliance and efficacy data for each appliance to provide an average ‘Treatment Effectiveness’ value, to make a ‘like-for-like’ comparison of two, very different, appliances possible. To summarize…

The MAS compliance value is 83% with an efficacy value of 50%. Conversely, CPAP’s has a much higher efficacy value score of 83% but a much lower compliance value of 50%. The conclusion made is that the effectiveness of MAS and CPAP treatment is in fact, the same.

Mandibular Advancement Splint

• Compliance value 83%
• Efficacy value 50%

CPAP machine

• Compliance value 50%
• Efficacy value 83%

 As a provider of MAS devices, I am obviously delighted with this relatively new finding. Nevertheless, I am not sure this is the full picture.

Whilst different CPAP machines are pretty similar to each other in relation to efficacy and compliance, the same cannot be said of MAS appliances. I can see why, for the purposes of the study above, it might be convenient to rate all MAS devices as the same but, in my experience, I find this observation somewhat problematic?  

MSi takes CPAP Head On!

As the owner of a specialist laboratory that provides a wide variety of such devices, the range of MAS efficacy and reputation is very evident.

What to look for in a Mandibular Advancement Splint

Over the years, I realised that, although some appliances are obviously better than others, even the best of the available designs often fall short in at least one of four crucial areas:

1. Comfort,

2. durability,

3. ease of use,

4. adjustment provision.

All except for one: the MSi, a relatively new appliance which was specifically developed to address all of these issues by tackling them head-on. One feature that is certainly significant in respect of this article, is the ability for the patient to self-adjust their device, to ensure maximum efficacy.

Patient compliance is key

Interestingly, without specialist CBCT imaging, the best person to judge when an MAS is adjusted correctly is often the patient, or their partner. Devices that need to be adjusted by a clinician typically take much longer to find the all-important ‘sweet spot’. This can also result in an excessive amount of protrusion being applied, to reduce anticipated patient dissatisfaction. However, unnecessary protrusion usually increases discomfort as well as non-compliance and may even result in complete non-use of the appliance.

Mandibular Advancement Splints including the MSi (pictured above) are now recommended in the NICE Guidelines for the treatment of mild, moderate and severe obstructive sleep apnoea.

In conclusion

The MAS data provided in this impressive publication, has been compiled from a wide variety of separate studies, using a selection of appliances, including some that are less than desirable. Given that we are inevitably talking averages in the Treatment Effectiveness review, I suspect the concluding efficacy/compliance figures are likely to be lower than they should be for the bulk of MAS patients. The big question is, how much lower? Unfortunately, until there is a new study which removes these anomalies, your guess is as good as mine, although I can’t help wondering what conclusions would be drawn from a MSi and CPAP head-to-head.

The views stated in this article are the views of Phil Chapman

Phil Chapman partnered with DB Lab Supplies to raise awareness of good practices for technicians and clinicians providing anti snoring devices for snorers and sufferers of mild to moderate obstructive sleep aponea. As creator of the Mandibular Snoring Inhibitor (MSi), Phil provides interesting articles that specifically highlight the benefits for patients, technicians and clinicians in choosing the Mandibular Snoring Inhibitor to ease the symptoms of snoring and mild to moderate obstructive sleep apnoea.

About Phil Chapman

Phil graduated in Industrial Design from Central St Martins in London and subsequently qualified as a dental technician. He founded and runs Labwise Dental in Sheffield. Phil specialises in providing simple solutions that solve complex issues and has designed, engineered and produced a diverse range of innovative products including the MSi Mandibular Advancement Device.

Other articles by Phil Chapman:

1.  How to Choose the Right Anti-Snoring Device
2. Jump on Board the Anti-Snoring Market with the MSi
3. Phil Chapman: Hats off to Dr. Christian Jessen and Britain’s Loudest Snorers
4. The MSi – “One Small Step For Man, One Giant leap For Snorers?

About DB Lab Supplies

It is our company mission to become a global leader in orthodontic and laboratory supplies. With over 45 years of experience, we recognise the importance of quality, service and innovation. Working to ISO13485 standards we strive for perfection in all that we do, from unique product design to the excellent service provided by our dedicated customer service and sales teams.

We are continually developing our product range, designing innovative products through consultation with leading industry experts throughout the world, to ensure that our products meet the high standards expected by today’s practitioners.