Patients with sleep apnea who are tired during the day because they can’t tolerate CPAP may be able to reduce daytime sleepiness by using a jaw support instead, suggests a research review in the Lancet Respiratory Medicine.

Researchers analyzed data from 67 studies with almost 6,900 patients and found patients had a greater reduction in daytime sleepiness with CPAP than with mandibular advancement devices (MAD).

But both options were effective enough that the choice of device might be left up to patients’ preferences, said senior study author Dr Malcolm Kohler, chair of respiratory medicine at the University Hospital of Zurich in Switzerland.

“Most doctors still consider CPAP as first-line treatment for patients with obstructive sleep apnea,” Kohler said by email. “If a patient cannot really use CPAP adequately e.g. only two to three hours per night, but does fine with a MAD which he can tolerate for seven hours a night, then he should be treated with a MAD.”