Sleep Quality with EPAP Enhanced Novel Mandibular Advancement Device (EMAD) versus Continuous Positive Airway Pressure (CPAP) in Mild and Moderate Obstructive Sleep Apnea (OSA)

<bold>Rationale:</bold> To compare self-reported sleep quality, treatment compliance, and respiratory event index (REI) after 1 year of treatment with EPAP enhanced novel MAD - O2Vent Optima+ExVent (EMAD) or CPAP in mild and moderate OSA. <bold>Materials and Methods:</bold> 46 mild and moderate OSA patients were treated with either EMAD or CPAP treatment and followed for 1 year. Data were collected through Level 1 PSG recordings, CPAP downloads, Epworth Sleepiness Scale (ESS), Stanford Sleepiness Scale (SSS) and Functional Outcomes of Sleep Questionnaire (FOSQ-10). We compared compliance, ESS, SSS, FOSQ-10 scores and REI between two the treatments. Reliable change index (RCI) was used to evaluate change in FOSQ global score. <bold>Results:</bold> Compliance with EMAD treatment (89.5%) was better than CPAP treatment (48.9%) at follow-up (P<0.001). Both groups had improved ESS, SSS and FOSQ-10 scores: EMAD (ESS:12.8.0±3.6 to 7.9±2.6; SSS: 3.4±1.2 to 2.2±0.7 FOSQ-10: 13.2±2.9 to 17.3±3.1; mean difference -2.9, (95% CI -3.5 to -2.4); P<0.001) and CPAP (ESS: 13.2±3.5 to 6.7±3.4, SSS: 3.3±1.1 to 2.2±0.9; FOSQ-10: 13.9±2.5 to 17.8±3.61; mean difference -3.1 (95% CI -3.2 to -2.4); P<0.001). More patients had improved FOSQ global score on the RCI in the EMAD group (43.6%) than in the CPAP group (16.7%) (P=0.01). Both treatments reduced REI to <10/hr. similarly; EMAD (84%) and CPAP (93%) (P=0.08). <bold>Conclusions:</bold> EMAD treatment was associated with better compliance and improved sleep quality than CPAP although REI was similarly reduced with both. We conclude that EMAD treatment should be considered a preferred treatment option than CPAP for mild and moderate OSA.