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Efficacy versus Effectiveness in the Treatment of Obstructive Sleep Apnea: CPAP and Oral Appliances

This article compares the concepts of efficacy and effectiveness between CPAP and oral appliance therapy.  Although CPAP is considered more efficacious in bringing down the apnea hypopnea index, or AHI, randomized trials suggest similar improvements in health outcomes between the two treatment modalities.  Health outcomes such as daytime sleepiness, quality of life, driving performance, and blood pressure seem to show similar improvement between CPAP and oral appliance therapy.

Excerpt from article:

ABSTRACT

Obstructive sleep apnea (OSA) is a chronic disorder and effective long-term treatment is necessary to prevent associated health risks. Standard treatment remains continuous positive airway pressure which is highly efficacious but has well-recognized limitations, with suboptimal patient acceptance and adherence rates, which in turn obviates the desired health benefits. The leading alternative device treatment is oral appliances. Patients often report preferring oral appliances to CPAP treatment, with better usage rates. However, unlike CPAP, inter-individual variability in the efficacy of oral appliance therapy means that patients are often left with some residual OSA. Despite discrepancies in efficacy (apnea-hypopnea index [AHI] reduction) between CPAP and oral appliances, randomized trials show similar improvements in health outcomes between treatments, including sleepiness, quality of life, driving performance, and blood pressure. Similar results in terms of health outcomes suggests that although the two treatments have different efficacy and treatment usage profiles, these result in similar overall effectiveness. In this narrative review, we discuss efficacy versus effectiveness in relation to CPAP and oral appliance treatment of OSA.

Citation:

Sutherland K, Phillips CL, Cistulli PA. Efficacy versus effectiveness in the treatment of obstructive sleep apnea: CPAP and oral appliances. Journal of Dental Sleep Medicine 2015;2(4):175–181.

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