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CPAP-Intolerant OSA — RACP Adult Medicine MCQ

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ModerateRespiratoryCPAP-Intolerant OSARACP Adult Medicine

A 55-year-old man with moderate OSA (AHI 20/hr) cannot tolerate CPAP despite mask changes, pressure adjustments, and humidification trials over 3 months. BMI is 28 kg/m². What is the most appropriate alternative treatment?

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Correct answer: C — Mandibular advancement device

For moderate OSA with CPAP intolerance, a mandibular advancement device (MAD) is the recommended second-line treatment. Custom-fitted devices advance the mandible forward, enlarging the posterior airway space. Efficacy is lower than CPAP but compliance is often better. Regular dental review is needed to monitor for TMJ issues and dental movement.

Reference: Australasian Sleep Association – 2024 – OSA Guidelines; AASM 2024