Effect of oral appliance therapy on blood pressure in Japanese patients with obstructive sleep apnea

Sekizuka, Hiromitsu; Osada, Naohiko; Akashi, Yoshihiro J.

doi:10.3109/10641963.2016.1148159

Cited by 9 publications

(11 citation statements)

References 31 publications

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“…Blood pressure is reduced from MAD treatment compared with placebo and mostly to a similar degree as with CPAP in the relatively small samples studied [5,9,11]. The blood pressure effects are particularly evident at night-time, in hypertensive patients and probably among females [18,[42][43][44][45][46][47]. Sex differences in effects from OSA treatments are mainly unknown, since mixed samples have included a majority of males (80% on average).…”

Section: Blood Pressure and Cardiovascular Healthmentioning

confidence: 99%

Update on oral appliance therapy

2019

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Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea–hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.

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Section: Blood Pressure and Cardiovascular Healthmentioning

confidence: 99%

Update on oral appliance therapy

2019

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“…20,21 Gotsopoulos et al 20 revealed a significant reduction with the 4 weeks of oral appliance therapy in mean 24hour diastolic blood pressure (1.8 6 0.5 mm Hg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. 20 Sekizuka et al 21 25 revealed daytime and nighttime SBP predicted all-cause and cardiovascular mortality, coronary heart disease, and stroke. Since it is still controversial whether nighttime or daytime BP can be a better prognostic factor for cardiovascular diseases, we calculated both nighttime and daytime BP preoperatively and postoperatively.…”

Section: Discussionmentioning

confidence: 97%

“…20,21 Gotsopoulos et al 20 revealed a significant reduction with the 4 weeks of oral appliance therapy in mean 24-hour diastolic blood pressure (1.8 ± 0.5 mm Hg) compared with the control ( P = .001) but not in 24-hour systolic blood pressure. 20 Sekizuka et al 21 demonstrated 237 Japanese patients with mild to moderate OSA with 8 to 12 weeks of oral appliance therapy. The antihypertensive effect of oral appliance therapy resulted in systolic BP of −2.4 ± 14.8 ( P = .078) and diastolic BP of −2.0 ± 11.7 mm Hg ( P = .045) in all patients.…”

Section: Discussionmentioning

confidence: 97%

“…The antihypertensive effect of oral appliance therapy resulted in systolic BP of −2.4 ± 14.8 ( P = .078) and diastolic BP of −2.0 ± 11.7 mm Hg ( P = .045) in all patients. 21 Nonsurgical OSA therapies, including CPAP and oral appliance, could significantly reduce BP; however, device compliance is the important concern. The published data on the effects of upper airway surgery for patients with OSA on BP are relatively limited.…”

Section: Discussionmentioning

confidence: 99%

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Alternations of Blood Pressure Before and After OSA Surgery

Tsai

Lin

et al. 2020

Otolaryngol.--head neck surg.

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Objective To investigate the changes of blood pressure (BP) on patients with obstructive sleep apnea/hypopnea syndrome (OSA) before and after upper airway surgery. Design Case series with chart review. Setting Tertiary academic medical center. Subjects and Methods Patients with OSA who underwent upper airway surgery were enrolled. We retrospectively investigated the nighttime and daytime BP before and at least 3 months after OSA surgery. Paired t test was used to compare the changes of BP before and after surgery. Generalized estimating equation was used to examine the prognostic significance of the variables in predicting the changes of postoperative BP. Results In total, 176 patients with OSA (149 men, 27 women; mean age, 42.9 years; mean apnea/hypopnea index, 43.1/h) were enrolled in this study. The overall nighttime and daytime BP decreased significantly before and after OSA surgery (daytime systolic BP was reduced from 137.3 ± 14.0 mm Hg to 132.7 ± 17.0 mm Hg, P < .01; nighttime systolic BP was reduced from 138.7 ± 16.0 mm Hg to 133.7 ± 15.3 mm Hg, P < .01; daytime diastolic BP was reduced from 87.7 ± 14.7 mm Hg to 84.9 ± 10.6 mm Hg, P = .01; nighttime diastolic BP was reduced from 85.4 ± 12.9 mm Hg to 83.1 ± 11.1 mm Hg, P = .02). The changes of nighttime systolic and diastolic BP were significantly associated with the improvement of percentage of O2 saturation <90% during polysomnography. Conclusion Surgical modifications of the upper airways for patients with OSA could benefit blood pressure.

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“…After consensus meetings, the reviewers agreed on the methodological quality of all articles. Nine articles were considered of low [37][38][39][40][41][42][43][44][45] and 16 articles of sufficient [46][47][48][49][50] methodological quality, including 11 RCTs (n=719 patients) [51][52][53][54][55][56][57][58][59][60][61] (Table 1 shows the study characteristics of articles with sufficient methodological quality).…”

Section: Resultsmentioning

confidence: 99%

Diagnostics and therapeutic options in obstructive and central sleep apnea syndrome

Vries¹

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Chapter 1 General introduction Chapter 2 Validity and predictive value of a portable two-channel sleepscreening tool in the identification of sleep apnea in patients with heart failure Response: A portable device as sleep-screening tool in the identification of obstructive sleep apnea in chronic heart failure: which value should we consider as cutoff? Chapter 3 Cardiovascular effects of oral appliance therapy in obstructive sleep apnea: A systematic review and meta-analysis Chapter 4 Clinical-and cost-effectiveness of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea Chapter 5 Long-term objective compliance of a mandibular advancement device versus continuous positive airway pressure in patients with moderate obstructive sleep apnea Chapter 6 Continuous positive airway pressure and oral appliance hybrid therapy in obstructive sleep apnea: patient comfort, compliance, and preference: A pilot study Chapter 7 Usage of positional therapy in adults with obstructive sleep apnea Chapter 8 Summary Chapter 9 General discussion and future perspectives Chapter 10 Nederlandse samenvatting Chapter 11 Dankwoord Chapter 1 General introduction 10 Screening and diagnostic tools Patients with sleep apnea present with a wide range of (co-)morbidities prior to their diagnosis. 32 These neurobehavioral and cardiovascular morbidities may support the consideration of having sleep apnea. Yet, establishing the diagnosis still frequently takes several years, leaving many subjects undiagnosed 33,34. Considering the abovementioned consequences of untreated sleep apnea and the impact on societal costs 33 , early diagnosis of sleep apnea is imperative. To date, sleep apnea remains underdiagnosed as it is difficult to recognize, despite the known risk factors. Polysomnography (PSG) is considered the gold standard for diagnosing sleep apnea and is typically performed in a sleep laboratory or ambulatory in a home setting. It entails recordings of (oro)nasal airflow, oxygen saturation, respiratory effort, sleep stages, snoring, eye-and leg movements, heart rate, and body position. Based on PSG, the severity of sleep apnea is classified by the number of apneas and/or hypopneas per hour of sleep (i.e. apneahypopnea index; AHI). Accordingly, sleep apnea can be classified as mild (AHI 5-15 events/h), moderate (AHI 15-30 events/h), or severe (AHI>30 events/h). As PSG is a time-consuming, costly, and specialized procedure, valid and simple alternatives are required. Polygraphy represents an alternative, but lacks the ability to identify sleep and sleep stages. Other diagnostic-and screening tools exist, for example: exclusively monitoring nasal flow and oxygen saturation, sometimes complemented with measurements of respiratory effort and pulse rate. Such devices have shown satisfactory results in terms of identifying patients with sleep apnea. Furthermore, several questionnaires, such as the Berlin questionnaire 34,35 , Epworth sleepiness scale 36 , STOP(-Bang) 37-39 , and several prediction ...

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Effect of oral appliance therapy on blood pressure in Japanese patients with obstructive sleep apnea

Abstract: A certain time period of OA therapy effected BP reduction in mild to moderate OSA patients without cardiac and/or cerebrovascular diseases. Its antihypertensive effect was greater in OSA patients whose BP was higher before receiving OA therapy.

Cited by 9 publications

References 31 publications

Update on oral appliance therapy

Update on oral appliance therapy

Alternations of Blood Pressure Before and After OSA Surgery

Diagnostics and therapeutic options in obstructive and central sleep apnea syndrome

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