Patient-Reported Quality of Life Outcomes with Mandibular Advancement versus CPAP: Insights from the CRESCENT Trial.

Objective: We compared mandibular advancement device (MAD) versus CPAP on quality-of-life (QoL) in a prespecified analysis of the CRESCENT trial.

Methods: 220 participants over age 40 with OSA, hypertension, and increased cardiovascular risk from three public hospitals were randomly assigned to MAD or CPAP (1:1). Multi-dimensional QoL questionnaires were administered at baseline, 6 months, and 12 months. Three sleep-related QoL questionnaires: Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and Sleep Apnea Quality of Life Index (SAQLI). Two generic QoL questionnaires: EuroQoL 5-D (EQ-5D) and Short Form 36 Health Survey (SF36).

Results: MAD adherence was 5.5 (3.9-6.9) hours at 6 months and 5.0 (3.3-6.1) hours at 12 months. CPAP adherence was 4.9 (3.3-6.1) hours at 6 months and 4.8 (3.3-5.7) hours at 12 months. Both groups showed improvements in sleep-related QoL. ESS improved at 6 and 12 months (p<0.001), with a between-group difference favoring CPAP at 6 months (Δ 1.45 [0.44 to 2.46], p=0.005). FOSQ improved at 6 and 12 months (p<0.001), with a between-group difference favoring CPAP at 12 months (Δ -0.91 [-1.77 to -0.05], p=0.038). SAQLI improved at 6 and 12 months (p<0.001) without between-group difference. For generic QoL questionnaires, SF-36 improved in most domains at 6 and 12 months, with Social Functioning section favoring CPAP at 12 months (p=0.013). EQ-5D improved at 12 months, with a trend favoring CPAP (p=0.053).

Conclusions: MAD and CPAP effectively improved sleep-related QoL and some aspects of generic QoL. CPAP improved sleep-related QoL to a greater extent than MAD.