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Introduction Continuous Positive Airway Pressure (CPAP) therapy has long been the gold standard treatment; however, its effectiveness is often compromised by poor patient compliance and intolerance. 1 Consequently, mandibular advancement devices (MADs) are recommended by NICE, particularly in cases of mild to moderate OSA where CPAP is not tolerated.This abstract presents findings from a retrospective quality improvement project (QIP) conducted at Nottingham University Hospitals (NUH) evaluating patient-reported outcomes following MAD therapy.Methods Patients unable to tolerate CPAP were referred to the Maxillofacial (Maxfacs) department for a customised MAD. OSA related clinical data were extracted from patient records, while subjective outcomes were assessed through a telephone questionnaire using a 5-point Likert scale(4).Results The QIP included 91 patients (70 male, 21 female) for MAD therapy between January and December 2024. Of these, 26 patients did not receive a device—11 were not registered with a dentist, and 2 were in the fitting process. Twenty-four patients were unreachable.Among 39 respondents (31 male, 8 female), MAD types included: Silensor (n=30), Monobloc (n=1), Sleepwell (n=1), and unknown models (n=7).75% of respondents preferred MAD therapy over CPAP.83% found the MAD easy or very easy to use.56% reported symptomatic improvement; 39% reported no change.53% experienced an improved quality of life, though 14% noted worsening due to reduced sleep quality.58% reported no adverse impact on daily functioning..Discussion MADs are generally well tolerated and represent a viable alternative to CPAP therapy for select cases. However, poor dentition or lack of access to dental care can limit availability. There is currently no standardised objective method to evaluate the effectiveness of MAD therapy post-issue.Recommendations Conduct repeat sleep studies 6–8 weeks after MAD initiationProvide spare device componentsEstablish a follow-up pathway for device malfunctionReference Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc 2008;5:173–8.