Evidence Summary

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Continuous positive airway pressure (CPAP) devices and mandibular advancement devices improve depressive symptoms in people with obstructive sleep apnea

Povitz M, Bolo CE, Heitman SJ, et al. Effect of treatment of obstructive sleep apnea on depressive symptoms: systematic review and meta-analysis. PLoS Med. 2014;11:e1001762.

Review question

Do continuous positive airway pressure (CPAP) devices and mandibular advancement devices improve depressive symptoms in people with obstructive sleep apnea?


For people with obstructive sleep apnea, upper airways are blocked during sleep and breathing can stop and start repeatedly. This can cause sleepiness, fatigue, memory problems, and irritability. Many people who have sleep apnea also have depression.

Treatment options for sleep apnea include CPAP devices and dental devices called mandibular advancement devices which fit over the teeth and hold the jaw forward. Both have been shown to improve sleep outcomes, but their effect on depression has not been clear.

How the review was done

The researchers did a systematic review, searching for studies published up to August 2014. They found 24 randomized controlled trials with 1732 people, mostly men (average age 42 to 78 years).

People in the trials were 18 years of age or older and had obstructive sleep apnea diagnosed during a sleep study.

CPAP or mandibular advancement devices were compared with sham treatment, placebo tablets, sham exercises, or no treatment.

Depressive symptoms were measured using validated depression questionnaires.

What the researchers found

CPAP and mandibular advancement devices each improved depressive symptoms. People with more depressive symptoms to begin with had greater improvements.


In people with obstructive sleep apnea, CPAP devices and mandibular advancement devices each improve depressive symptoms.

Effect of treatments for obstructive sleep apnea on depressive symptoms in adults


Number of trials (number of people)

Effect of treatment on depressive symptoms

Continuous positive airway pressure (CPAP) devices

19 trials (1,355 people)

Improved depressive symptoms

Mandibular advancement devices

5 trials (440 people)

Improved depressive symptoms



A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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