Nocturnal heart rate variability may be useful for determining the efficacy of mandibular advancement devices for obstructive sleep apnea

A mandibular advancement device (MAD) is recommended as an alternative therapy for obstructive sleep apnea (OSA), which effectively reduces the collapsibility of the upper airway during sleep by advancing the mandible. However, the effects of MAD therapy on cardiac autonomic modulation remain unclear. We evaluated the effects of MAD on nocturnal heart rate variability (HRV) in OSA. Anthropometric data, questionnaire results, and HRV parameters (evaluated using time domain and frequency domain methods) of 58 adult patients with OSA treated with MAD therapy were retrospectively reviewed. All patients underwent polysomnography at baseline and 3-month follow-up. The average normal-to-normal (NN) interval, standard deviation of the NN interval, low-frequency power in normalized units (LFnu), and high-frequency power in normalized units (HFnu) showed significant changes with MAD therapy. Based on the criteria for success (decrease in the apnea-hypopnea index by >50% and value <20/h), 34 and 24 patients were classified into the response and nonresponse groups, respectively. No differences in baseline characteristics were detected between groups, except for higher body mass index and lower minimal oxygen saturation in the nonresponse group. A subgroup analysis indicated that the average NN interval and HFnu significantly increased, and that Total power (TP), very low frequency, low frequency(LF), low frequency/high frequency and LFnu significantly decreased compared to baseline in the response group; however, no HRV changes were found in the nonresponse group. After adjusting for age, sex, and body mass index, the response group showed significant changes from baseline in TP and LF compared to the nonresponse group. Therefore, HRV may be useful for determining the efficacy of MAD therapy in OSA.