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Introduction Nationally access to Mandibular Advancement splints (MAD’s) for treatment of Obstructive Sleep Apnoea (OSA) is inconsistent. Nice guidelines (No. 202.) recommend MAD’s for the treatment of OSA as an alternative to Continuous positive Airway Pressure (CPAP). However, access to this treatment varies across the NHS. The aim of this retrospective audit was to determine what proportion of CPAP intolerant patients could be eligible for MAD’s in the trust and highlight the potential need for service development.Methods Between July and November 2024, 100 patients with a diagnosis of OSA had returned their CPAP machine due to intolerance and had been discharged from the sleep service. A review of these patients OSA severity and eligibility for MAD was conducted using the NICE criteria (No.202). AHI had previously been graded using AASM 2007. Snore was reviewed in the mild OSA group where snore was considered significant if >10% of total breaths per night (Iber et al. AASM Manual for the Scoring and Sleep and Associated Events. 2007).Results Of the 100 patients reviewed, 60 were deemed potentially eligible for an MAD trial assuming they had optimal dental and periodontal health. Among these, 49% had severe OSA, 6% had moderate OSA, and 5% had mild OSA with significant snoring. Figure 1 presents a pie chart illustrating the distribution of patients who returned their CPAP devices based on OSA severity.Abstract P25 Figure 1Conclusion While CPAP remains the gold standard for treatment of OSA, this audit highlights the potential need for alternative management strategies for the significant amount of patient‘s intolerant of CPAP (Marklund et al. ERJ 39(5), 1241–1247). To establish formal pathways for MAD therapy, a collaborative approach between the sleep service (CPAP) and the dental team (MAD) is essential.