Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea

Gagnadoux, Frédéric; Pépin, Jean‐Louis; Vielle, Bruno; Bironneau, Vanessa; Chouet-Girard, Frédérique; Launois, Sandrine; Meslier, Nicole; Meurice, J.-C.; Nguyên, Xuân-Lan; Paris, Audrey; Priou, Pascaline; Tamisier, Renaud; Trzépizur, Wojciech; Goupil, F.; Fleury, Bernard

doi:10.1164/rccm.201609-1817oc

Cited by 56 publications

(88 citation statements)

References 49 publications

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“…As described previously,6 patients with severe OSA (Apnoea–Hypopnoea Index (AHI)>30) and no overt CVD were randomly assigned to receive 2 months of treatment with either a custom-made effective MAD or a sham device with objective measurement of treatment adherence by an embedded microsensor (see online supplementary figure E1). Overnight in-lab polysomnography and blood sample collections were performed at baseline and after the 2-month treatment period.…”

Section: Methodsmentioning

confidence: 99%

“…A sample size calculation was performed for the primary endpoints of the main study 6. Only patients with available biomarkers before and after the 2-month intervention were included in the present per-protocol analysis.…”

Section: Methodsmentioning

confidence: 99%

“…Despite the superior efficacy of CPAP in reducing OSA severity, most trials comparing MAD and CPAP have reported similar health outcomes 4 5. In a recent multicentre randomised controlled trial, our group evaluated the impact of 2 months of effective MAD therapy versus a sham device on endothelial function in patients with severe OSA 6. The aim of the present ancillary study was to investigate the effects of MAD therapy on circulating levels of inflammatory and metabolic biomarkers.…”

Section: Introductionmentioning

confidence: 99%

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Effect of mandibular advancement therapy on inflammatory and metabolic biomarkers in patients with severe obstructive sleep apnoea: a randomised controlled trial

Recoquillon

Pépin

Vielle

et al. 2018

Thorax

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Systemic inflammation and metabolic disorders are among the mechanisms linking obstructive sleep apnoea (OSA) and cardiovascular disease (CVD). In 109 patients with severe OSA and no overt CVD, biomarkers of inflammation (C reactive protein, interleukin-6, tumour necrosis factor-α and its receptors, adiponectin, leptin and P-selectin), glucose and lipid metabolism, and N-terminal pro-brain natriuretic peptide, were measured before and after 2 months of treatment with a mandibular advancement device (MAD) (n=55) or a sham device (n=54). MAD reduced the Apnoea–Hypopnoea Index (p<0.001) but had no effect on circulating biomarkers compared with the sham device, despite high treatment adherence (6.6 hour/night).Trial registration numberNCT01426607.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of mandibular advancement therapy on inflammatory and metabolic biomarkers in patients with severe obstructive sleep apnoea: a randomised controlled trial

Recoquillon

Pépin

Vielle

et al. 2018

Thorax

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“…Three trials reported no effect versus placebo,3, 5, 6 one study reported a reduction in daytime blood pressure,7 and another reported a reduction in nocturnal diastolic blood pressure 4. The sixth study reported no difference between a mandibular advancement device and continuous positive airway pressure, but there was no difference in blood pressures versus baseline with either treatment 8.…”

mentioning

confidence: 99%

“…We identified 6 randomized controlled trials using mandibular advancement devices for sleep apnea with 24‐hour blood pressure as the outcome 3, 4, 5, 6, 7, 8. Three trials reported no effect versus placebo,3, 5, 6 one study reported a reduction in daytime blood pressure,7 and another reported a reduction in nocturnal diastolic blood pressure 4.…”

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Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Rietz

Franklin

Carlberg

et al. 2018

JAHA

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BackgroundObstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea‐hypopnea index, <30).Methods and ResultsIn this 4‐month, double‐blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24‐hour blood pressure measurements were performed at baseline and at follow‐up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0–17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea‐hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7–10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.ConclusionsA mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

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Screening for Obstructive Sleep Apnea in Adults

Jonas¹,

Amick²,

Feltner³

et al. 2022

JAMA

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ImportanceObstructive sleep apnea (OSA) is associated with adverse health outcomes.ObjectiveTo review the evidence on screening for OSA in asymptomatic adults or those with unrecognized OSA symptoms to inform the US Preventive Services Task Force.Data SourcesPubMed/MEDLINE, Cochrane Library, Embase, and trial registries through August 23, 2021; surveillance through September 23, 2022.Study SelectionEnglish-language studies of screening test accuracy, randomized clinical trials (RCTs) of screening or treatment of OSA reporting health outcomes or harms, and systematic reviews of treatment reporting changes in blood pressure and apnea-hypopnea index (AHI) scores.Data Extraction and SynthesisDual review of abstracts, full-text articles, and study quality. Meta-analysis of intervention trials.Main Outcomes and MeasuresTest accuracy, excessive daytime sleepiness, sleep-related and general health–related quality of life (QOL), and harms.ResultsEighty-six studies were included (N = 11 051). No study directly compared screening with no screening. Screening accuracy of the Multivariable Apnea Prediction score followed by unattended home sleep testing for detecting severe OSA syndrome (AHI ≥30 and Epworth Sleepiness Scale [ESS] score &gt;10) measured as the area under the curve in 2 studies (n = 702) was 0.80 (95% CI, 0.78 to 0.82) and 0.83 (95% CI, 0.77 to 0.90). Five studies assessing the accuracy of other screening tools were heterogeneous and results were inconsistent. Compared with inactive control, positive airway pressure was associated with a significant improvement in ESS score from baseline (pooled mean difference, −2.33 [95% CI, −2.75 to −1.90]; 47 trials; n = 7024), sleep-related QOL (standardized mean difference, 0.30 [95% CI, 0.19 to 0.42]; 17 trials; n = 3083), and general health–related QOL measured by the 36-Item Short Form Health Survey (SF-36) mental health component summary score change (pooled mean difference, 2.20 [95% CI, 0.95 to 3.44]; 15 trials; n = 2345) and SF-36 physical health component summary score change (pooled mean difference, 1.53 [95% CI, 0.29 to 2.77]; 13 trials; n = 2031). Use of mandibular advancement devices was also associated with a significantly larger ESS score change compared with controls (pooled mean difference, −1.67 [95% CI, 2.09 to −1.25]; 10 trials; n = 1540). Reporting of other health outcomes was sparse; no included trial found significant benefit associated with treatment on mortality, cardiovascular events, or motor vehicle crashes. In 3 systematic reviews, positive airway pressure was significantly associated with reduced blood pressure; however, the difference was relatively small (2-3 mm Hg).Conclusions and RelevanceThe accuracy and clinical utility of OSA screening tools that could be used in primary care settings were uncertain. Positive airway pressure and mandibular advancement devices reduced ESS score. Trials of positive airway pressure found modest improvement in sleep-related and general health–related QOL but have not established whether treatment reduces mortality or improves most other health outcomes.

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Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea

Abstract: In moderately sleepy patients with severe OSA, mandibular advancement therapy reduced OSA severity and related symptoms but had no effect on endothelial function and blood pressure despite high treatment compliance. Clinical trial registered with www.clinicaltrials.gov (NCT 01426607).

Cited by 56 publications

References 49 publications

Effect of mandibular advancement therapy on inflammatory and metabolic biomarkers in patients with severe obstructive sleep apnoea: a randomised controlled trial

Effect of mandibular advancement therapy on inflammatory and metabolic biomarkers in patients with severe obstructive sleep apnoea: a randomised controlled trial

Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Screening for Obstructive Sleep Apnea in Adults

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