The Many Faces of Equal Effectiveness When Comparing CPAP and MAD Therapy for OSA

 In 1965, Gastaut et al. provided the first comprehensive account of obstructive sleep apnea syndrome (OSAS), describing polysomnography in obese hypersomnolent patients with frequent nocturnal apneas. In 1978, Remmers et al. reported on a nocturnal cyclic ventilatory pattern that consisted of a series of regular inspiratory efforts against an occluded airway alternating with a period of regular breathing with the pharynx, and not the larynx, being the site of upper airway occlusion during sleep.

The main pathophysiological feature of OSAS is indeed obstruction in the collapsible segment of the pharynx during sleep leading to nocturnal hypoxemia and sleep fragmentation. OSAS is associated with cardiovascular co-morbidities, and overall increased cardiovascular mortality, as well as metabolic dysfunction. The prevalence of this chronic disease is remarkably high with prevalence of moderate-to-severe OSAS reported to be as high than 23% in women and 50% in men, respectively. It remains to be established whether treating OSAS can fully reverse its chronic consequences.

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Vanderveaken; CPAP and OAT are comparable Tx modalities.pdf

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