Combination Therapies with an Oral Appliance in the Management of Obstructive Sleep Apnea

Abstract

Combination therapy (CT) with a mandibular advancement device (MAD) and positive airway pressure (PAP) has been advocated for patients for whom neither MAD alone nor PAP alone provides an efficacious and tolerated therapy. This article reviews the small and limited, but growing body of evidence in support of CT and highlights details in its implementation. In most studies, CT was found to be preferred by many, but not all PAP-intolerant patients. Combination therapy can be more efficacious than either MAD or PAP alone. The effective positive airway pressure of CT is often less than with PAP alone, likely explaining in part better adherence to CT.