Focusing on total breathing events throughout the night and quality of life during the day can provide a clearer picture of how well oral appliances stack up against CPAP for patients with mild to moderate obstructive sleep apnea.

By Lisa Rapaport

In a highly controlled environment—such as in a sleep disorders center for a titration study, continuous positive airway pressure (CPAP) is highly efficacious for every obstructive sleep apnea (OSA) patient. It reliably brings down the apnea-hypopnea index (AHI) to below 5, meaning the patient has no sleep apnea at all—as long as they are actively using the CPAP device.

But patients don’t live in a controlled environment. Once they go home, many of them either stop using their CPAP device entirely or use it for only the first few hours of sleep before pulling the mask off. This results in residual sleep apnea during all the hours when they are not using their CPAP device.

“There is a difference between efficacy and effectiveness,” says Ofer Jacobowitz MD, PhD, FAASM, FAAOA, co-director of Sleep, ENT and Allergy Associates in New York City and an associate professor of otolaryngology at the Zucker School of Medicine at Hofstra/Northwell.

“CPAP therapy is very efficacious and will almost always normalize the AHI,” Jacobowitz says. “At the home setting, however, effectiveness based on real-world outcome is not the same.”

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