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The letter by Dr. Mahadevappa Hunasikatti criticizes a meta-analysis by Kuhn et al., published in CHEST, which compared the effects of CPAP and mandibular advancement devices (MADs) on health-related quality of life in obstructive sleep apnea (OSA) patients. Dr. Hunasikatti argues that the claim that MADs may be as effective as CPAP is inaccurate. He outlines that the meta-analysis does not establish the effectiveness of these devices due to the lack of high-quality randomized controlled trials needed to substantiate such claims. The validity of such analyses, according to him, depends on appropriate identification of studies, trial quality, and absence of biases.<br /><br />Dr. Hunasikatti points out that treatment decisions for OSA often hinge on symptoms, and notes that polysomnograms or sleep tests are typically not conducted for asymptomatic individuals, following the guidelines which recommend treatment only when OSA symptoms are present. He emphasizes the importance of measuring treatment efficacy by the apnea-hypopnea index (AHI) and asserts that, while CPAP has shown better odds for achieving target AHI in moderate to severe OSA cases, it may be appropriate to consider oral appliances for those intolerant to CPAP, especially in mild to moderate cases.<br /><br />The response from the authors of the original study acknowledges Dr. Hunasikatti’s input and provides further context to the original findings, though the response text itself is not fully included in this excerpt. Dr. Hunasikatti and the authors both contribute to the ongoing discussion about the clinical application and research assessments of CPAP and MADs in the treatment of OSA.
Keywords
Dr. Mahadevappa Hunasikatti
meta-analysis
CPAP
mandibular advancement devices
obstructive sleep apnea
health-related quality of life
randomized controlled trials
apnea-hypopnea index
treatment efficacy
clinical application
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