Mandibular Advancement Device Benefits: 

Studies of mandibular advancement devices (MADs) for obstructive sleep apnea (OSA) and primary snoring have measured benefits ranging from fewer breathing interruptions and reduced snoring to improvements in daytime sleepiness. Researchers have also examined nightly use, blood pressure, and whether benefits persist over several years.

This research overview from Dr. Rami Hamed Center explains six benefits and the evidence behind them. The statistics come from published international studies and do not represent DRHC patient outcome data.

1. Fewer breathing interruptions during sleep

A 2016 meta-analysis pooled 11 randomised trials comparing MADs with conservative or inactive treatments, including sham devices and usual care. The average difference favoured MAD treatment by approximately 9.3 breathing events per hour. The 95% confidence interval was 6.3 to 12.3 fewer events per hour. ^[1]

Why this benefit matters: The apnea-hypopnea index (AHI) counts breathing pauses and episodes of reduced airflow per hour of sleep. A lower AHI means fewer interruptions. This research supports a measurable reduction in obstructive events, although results varied between studies, and most treatment periods were short. A reduction does not necessarily mean breathing has returned to normal.

2. Reduced daytime sleepiness

A 2015 network meta-analysis covering 67 studies and 6,873 participants across all treatment groups found that MADs improved the Epworth Sleepiness Scale by an average of 1.7 points compared with inactive treatment. The 95% confidence interval was 1.1 to 2.3 points. ^[2]

Why this benefit matters: The questionnaire measures the tendency to doze in everyday situations. Scores range from 0 to 24, with lower scores indicating less sleepiness. The pooled result represents a modest average improvement. It does not show that every patient becomes fully alert or gains the same benefit.

3. Meaningful reduction in snoring

In a small 2024 randomised trial, 50 people with primary snoring and their sleeping partners were assigned to a MAD or combined airway and positional therapy. After four weeks, partners rated snoring as much or very much improved in 21 of 23 MAD completers (91%), compared with 11 of 19 completers (58%) receiving the other treatment. ^[3]

Why this benefit matters: Sleeping partners noticed a substantial improvement in snoring. The difference between groups was 33 percentage points, with a 95% confidence interval of 8 to 58 percentage points. This was a small, short study of primary snoring. Its 91% response rate describes perceived improvement, not complete snoring elimination or a sleep apnea cure rate.

4. Longer nightly use in a randomised comparison

The CHOICE trial, published in its journal issue in 2025, included 73 participants in its crossover analysis. Each participant tried both treatments. Objectively recorded use over one month averaged 6.0 hours per night with a mandibular advancement splint and 5.3 hours with CPAP: a difference of about 42 minutes. ^[4]

Why this benefit matters: The result suggests that some patients find an oral appliance easier to use consistently. The 95% confidence interval for the additional nightly use was 0.3 to 1.2 hours. However, this measures adherence, not breathing control: CPAP reduced respiratory events more effectively in the same trial.

5. A possible modest blood-pressure benefit

The 2024 CRESCENT trial randomised 220 adults with moderate-to-severe OSA, hypertension and increased cardiovascular risk. At six months, the MAD group had a 2.5 mmHg reduction in 24-hour mean arterial blood pressure from baseline. MAD met the study's predefined criterion for being no worse than CPAP by an acceptable margin on this specific blood-pressure outcome. ^[5]

What the evidence supports: A modest blood-pressure improvement in this selected population in Singapore. The finding does not establish the prevention of heart attacks or strokes. Wider evidence remains mixed: a 2026 review did not find statistically significant pooled blood-pressure reductions against inactive controls. ^[7]

6. Sustained improvement over five years in some patients

In the ORCADES observational study, five-year data were available for 172 of 331 patients treated with a particular custom MAD after refusing or not tolerating CPAP. At five years, 52% of those evaluated achieved at least a 50% reduction in AHI from baseline. ^[6]

Why this benefit matters: Improvement can persist beyond the first few months. However, this manufacturer-funded study defined success as a relative reduction, which did not require normal breathing results. Nearly half the original group lacked five-year data, so the percentage cannot be applied to everyone who starts using a MAD.

How to interpret MAD benefit statistics

These studies measure different outcomes. Reduced snoring, lower AHI, less sleepiness, and longer nightly use are separate benefits. A high response rate for one does not establish the same response for another.

A 95% confidence interval describes uncertainty around a study's estimated effect. It is not the range of results that every individual can expect.

Research supports meaningful benefits for some patients, but there is no universal MAD success percentage. Results depend on the study population, appliance, duration, and definition of improvement. In particular, the snoring trial's 91% response and the five-year study's 52% success rate should not be combined or compared as if they measured the same result.

Research referenced on this page

1. Sharples et al. MAD and CPAP randomised-trial meta-analysis. Sleep Medicine Reviews, 2016.
2. Bratton et al. CPAP, MADs, and sleepiness: network meta-analysis. The Lancet Respiratory Medicine, 2015.
3. Ioerger et al. MAD versus combined airway and positional therapy for snoring. JAMA Otolaryngology–Head & Neck Surgery, 2024.
4. Hamoda et al. CHOICE randomised clinical trial. European Respiratory Journal, 2025; first published online in 2024.
5. Ou et al. CRESCENT trial: MAD versus CPAP for blood-pressure reduction. Journal of the American College of Cardiology, 2024.
6. Vecchierini et al. ORCADES five-year follow-up. Journal of Clinical Sleep Medicine, 2021.
7. Cheng et al. MADs versus CPAP: blood-pressure systematic review and meta-analysis. Frontiers in Neurology, 2026.

Call 04 279 8200 to book your sleep apnea consultation at Dr. Rami Hamed Center in Dubai.