Adherence to CPAP with a nasal mask combined with mandibular advancement device versus an oronasal mask: a randomized crossover trial

Sleep Breath. 2019 Sep;23(3):885-888. doi: 10.1007/s11325-018-01772-5. Epub 2019 Jan 28.


Purpose: Evidence for the management of CPAP-treated obstructive sleep apnea suggests that oronasal masks reduce mouth leaks at the expense of higher pressures and poorer adherence. Some authors have proposed the use of mandibular advancement devices in combination with nasal masks to address this. The aim of this study was to assess adherence to CPAP after 1 month's use of a nasal mask with a mandibular advancement device and to compare adherence with an oronasal mask.

Methods: A randomized crossover trial design to assess whether a mandibular advancement device combined with a nasal mask would improve CPAP adherence compared to an oronasal mask.

Results: There was no improvement in CPAP adherence and self-reported interface-related pain was significantly higher with the combined treatment.

Conclusions: Although the combined treatment reduced pressures, likely by improving upper airway patency, it may only be appropriate for a small number of patients due to associated discomfort.

Trial registration: NCT01889472.

Keywords: Continuous positive airway pressure; Mandibular advancement device; Nasal mask; Obstructive sleep apnea; Treatment adherence and compliance.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Continuous Positive Airway Pressure / methods*
  • Cross-Over Studies
  • Equipment and Supplies
  • Female
  • Humans
  • Male
  • Mandibular Advancement / methods*
  • Masks*
  • Middle Aged
  • Nose
  • Patient Compliance*
  • Sleep Apnea, Obstructive / therapy*

Associated data