Mandibular advancement devices (MAD) are an effective alternative to continuous positive airway pressure (CPAP) for managing obstructive sleep apnea (OSA), particularly in patients who cannot tolerate CPAP. By repositioning the mandible, MAD enhance airflow and airway patency. Recent guidelines from the American Academy of Sleep Medicine and the European Respiratory Society emphasize the importance of custom-made, titratable devices, and interdisciplinary collaboration in patient care. Treatment success depends on clinical and anatomical factors such as younger age, lower BMI, and specific craniofacial structures. While CPAP is more effective in reducing respiratory events, MAD provide comparable real-world benefits due to higher adherence, though long-term use may cause occlusal changes. Future research should refine predictive markers, optimize device design, integrate digital tools, and assess long-term health outcomes to enhance MAD effectiveness in OSA management.