The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment

Abstract

Study Objectives: To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-hour ambulatory blood pressure monitoring and peripheral arterial tonometry at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in a subgroup who had an apnea-hypopnea index of < 5 events/h and adherence of ≥ 4 hours per night (effective-treatment subgroups). Methods: The inclusion criteria were individuals with mild obstructive sleep apnea, any sex, age between 18 and 65 years, and a body mass index of ≤ 35 kg/m 2 . Patients were randomized into CPAP, MAD, and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-hour ambulatory blood pressure monitoring, and peripheral arterial tonometry at baseline and after 6 and 12 months. A generalized linear mixed model was used for comparisons. Results: The CPAP and MAD groups had lower apnea-hypopnea indexes than the control group at 6 and 12 months, and the CPAP group had higher blood oxygen levels (SpO 2 ) than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/night; CPAP: 3.8 ± 3.4 h/night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to peripheral arterial tonometry or 24-hour ambulatory blood pressure monitoring outcomes. Conclusions: Treatment of mild obstructive sleep apnea with CPAP or MAD did not improve blood pressure or endothelial function after 1 year, even in patients with effective treatment.

The multisystemic effects of oral appliance therapy for obstructive sleep apnea: A narrative review

“…In contrast, Gagnadoux et al [ 64 ] compared MAD with an inactive OA, where MAD therapy significantly improved AHI and related symptoms but did not affect endothelial function. Similarly, Guimarães et al [ 65 ] found no significant changes in endothelial function despite effective OSA treatment with MAD or CPAP for 6 and 12 months.…”

The role of oral appliance therapy in obstructive sleep apnoea

“…An RCT that assessed the impact of 2 months of OAT on endothelial dysfunction in severe, nonsleepy OSA patients with no overt cardiovascular disease showed no positive effects [ 110 ]. Similarly, a recently published RCT comparing the effect of CPAP and OAT on effectively treated mild OSA patients showed no impact of either treatment on endothelial function or BP, following 1 year of treatment [ 111 ]. However, both CPAP and OAT were equally effective in reducing the risk of mortality in patients with severe OSA in an observational study [ 38 , 112 ].…”

Current and novel treatment options for obstructive sleep apnoea

“…Bite changes might also introduce a risk of reduced efficacy, if the device is left unadjusted. Stable blood pressure effects from MAD have been reported [ 76 , 85 ], while a lack of effect on blood pressure from both MAD and CPAP was found in other studies in mild and moderate OSA patients after 1 year [ 86 , 87 ]. One recent study observed significant reverse left ventricular hypertrophic remodelling after 6 months’ successful MAD therapy [ 88 ].…”