Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis

Imran H. Iftikhar, Lia Bittencourt, Shawn Youngstedt, Najib Ayas, Peter Cistulli, Richard Schwab, Martin W. Durkin, Ulysses J. Magalang

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Study objective To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA). Design Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception – September 8, 2015). Patients Individuals with OSA. Interventions CPAP, MADs, exercise training, and dietary weight loss. Results CPAP decreased apnea–hypopnea index (AHI) the most [by 25.27 events/hour (22.03–28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [−8.04 (−17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [−10.06 (−14.21 to −5.91) and −7.82 (−13.04 to −2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68–5.48)], albeit with a non-significant difference compared to MADs and CPAP. Conclusions CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalSleep Medicine
StatePublished - Feb 1 2017


  • Aerobic exercise training
  • Continuous positive airway pressure
  • Dietary weight loss
  • Mandibular advancement device
  • Network meta-analysis

ASJC Scopus subject areas

  • Medicine(all)


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