Key PointsQuestion
Are mandibular advancement devices more effective than airway and positional therapy for patients with primary snoring?
Findings
In this pilot randomized clinical trial of 50 couples, partners reported that more people who snore who were randomized to use the mandibular advancement device experienced a clinically meaningful and statistically significant reduction in snoring and improvement in sleep compared with those randomized to combined airway and positional therapy.
Meaning
The results of this randomized clinical trial indicate that mandibular advancement device and combined airway and positional therapy reduced snoring and improved sleep in people who snore and their sleeping partners, but dyads in the mandibular advancement device group experienced a larger clinically meaningful improvement than the airway and positional therapy group.
Importance
Approximately 150 million individuals in the US snore in the absence of obstructive sleep apnea (primary snoring), but few studies have examined the efficacy of treatments for snoring or evaluated the effect of snoring in sleeping partners.
Objective
To evaluate the efficacy of 2 treatments for primary snoring.
Design, Setting, and Participants
This pilot randomized clinical trial that included a convenience sample of people who snore without sleep apnea and their sleeping partner who underwent 4 weeks of snoring treatment was conducted at an academic medical center between October 3, 2022, and July 3, 2023.
Interventions
Fifty couples were randomized to either use a mandibular advancement device (MAD) or receive combined airway and positional therapy (CAPT; external nasal dilator, nasal saline lavage with mometasone, mouth taping, and lateral positional therapy).
Main Outcome and Measure
Percentage of sleeping partners who reported that their partner’s snoring was either very much improved or much improved (responder) on the Clinical Global Impression of Improvement scale.
Results
A total of 42 dyads completed the study; 23 (55%) were randomized to MAD and 19 (45%) to CAPT. Among people who snore, 26 (62%) were female, and the mean (SD) age was 48 (14) years. Of 23 dyads randomized to MAD, 21 people who snore (91%) were rated by the sleeping partner as a responder, while 11 of the 19 dyads (58%) randomized to CAPT were rated by the sleeping partner as responder, resulting in a difference of 33 percentage points (95% CI, 8-58) and a number needed to treat of 3. Of the 10 participants who were withdrawn, 4 were withdrawn due to adverse effects of the treatment that were evenly distributed between the MAD (n = 2) and CAPT (n = 2) groups.
Conclusion and Relevance
The results of this randomized clinical trial showed that the MAD may be more effective than CAPT for treating primary snoring, while both treatment options were found to reduce primary snoring. Physicians should have a patient-centered discussion to determine which treatment is best for individual patients with primary snoring, weighing convenience, adverse effects, and cost as factors.
Trial Registration
ClinicalTrials.gov Identifier: NCT05756647