Positional Obstructive Sleep Apnea: MAD as an alternative to CPAP

In clinical settings, many patients experience more severe OSA while asleep in the supine position than in the lateral position. 9,10 Individuals are defined as positional OSA (P-OSA) if their overall apnea-hypopnea index (AHI) is higher than 5 events/h, and the ratio of their lateral AHI to supine AHI is 0.5 or less. A substantial number of studies demonstrated that P-OSA is present in 50% to 60% of patients who undergo polysomnography.

Furthermore, a few reports suggested that P-OSA patients responded better to MAD than patients with non-positional OSA (NP-OSA). Since P-OSA is likely to be a common OSA phenotype that can be detected by diagnostic polysomnography, MAD treatment for P-OSA patients may result in increased treatment efficacy and offer a patient tailored and cost-effective approach to OSA.

Obstructive Sleep Apnea: Positional OSA vs Non-Positional OSA


Study subjects

Positional obstructive sleep apnea (P-OSA) is a clinically common phenotype of OSA, which can be treated effectively with mandibular advancement devices (MADs). We hypothesized that the efficacy of an MAD is comparable to that of nasal continuous positive airway pressure (nCPAP) in P-OSA patients.

Mandibular Advancement Device from OrthoApnea

Mandibular Advancement Device from OrthoApnea


There were no significant differences in baseline AHI (MAD: nCPAP = 20.6 ± 3.9/h: 21.3 ± 1.7/h, p = 0.35) or in follow-up AHI (MAD: nCPAP = 4.7 ± 3.5/h: 3.4 ± 3.7/h, p = 0.12) between the 2 treatment groups, and hence MADs lowered the AHI to the same extent as nCPAP.


These findings suggest that an MAD is as efficacious as nCPAP for P-OSA patients. MAD treatment for this specific phenotype may be a promising patient-tailored and first-line approach to OSA.

A Mandibular Advancement Devices (DAM) is as efficacious as nCPAP for Positional Obstructive Sleep Apnea (P-OSA) patients .

The 55,9% of the patients with sleep apnea have positional sleep apnea, according to Oksenberg et al., 1997.

2016 Takaesu Y MAD as a Comparable Treatment to Nasal CPAP for Positional OSA J Clin Sleep Med 121113–1119

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