03/28/2026
A useful reminder from the sleep medicine literature: efficacy and adherence are not the same thing.
This 2025 systematic review comparing CPAP and mandibular advancement devices in obstructive sleep apnea reinforces a clinically important point:
• CPAP remains the most effective therapy for reducing AHI and improving oxygenation, especially in moderate to severe OSA.
• Mandibular advancement devices continue to show stronger adherence, comfort, and long-term usability particularly in mild to moderate cases or in patients who struggle with CPAP tolerance.
In practice, long-term success depends on more than theoretical efficacy.
It depends on whether the treatment fits the patient’s anatomy, airway behavior, tolerance, and ability to sustain use over time.
This is where dental sleep medicine and oral-systemic evaluation become highly relevant.
For the right patient, a properly selected custom oral appliance is not a secondary conversation. It is part of a serious, evidence-based treatment pathway.
For clinicians working with OSA patients, this review is worth reading.
https://doi.org/10.1111/jsr.70192
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