What is the clinical evidence from this study?

Study design: RCT. Population: Obstructive sleep apnea (OSA) (n=40). Intervention: Mandibular advancement device (MAD) vs. Continuous positive airway pressure (CPAP). Primary outcome: Continuous diastolic blood pressure during spontaneous breathing (mmHg).

October 13, 2015Open Access

Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime

Q: What does this research mean for the field?

Both mandibular advancement device (MAD) and continuous positive airway pressure (CPAP) therapy significantly reduce daytime continuous diastolic blood pressure to a similar extent in patients with obstructive sleep apnea. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Both mandibular advancement device and continuous positive airway pressure therapy significantly reduced daytime continuous diastolic blood pressure to a similar extent in patients with obstructive sleep apnea.

Study Design

Type

RCT (n=40)

Blinding

Open-label

Randomization

Crossover

Multicenter

Structured PICO

Does mandibular advancement therapy compared to CPAP improve daytime cardiac autonomic function in patients with obstructive sleep apnea?

Population

40 patients with obstructive sleep apnea (AHI ≥5/h), mean age 49.5, 33 male. Key exclusions: periodontitis, central sleep apnea syndrome, severe cardiovascular risk.

Intervention

Mandibular advancement therapy (MAD) during sleep for 12 weeks

Comparator

Continuous positive airway pressure (CPAP) therapy during sleep for 12 weeks (crossover design)

Outcome

Daytime cardiac autonomic function measured by heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under spontaneous and controlled breathingsurrogate

Both mandibular advancement therapy and CPAP provide similar beneficial reductions in daytime diastolic blood pressure in patients with obstructive sleep apnea, although CPAP is more effective at eliminating respiratory events.

Main Result

Absolute Event Rate: 60.5% vs 60.9%

Limitations

Objective wear-time sensors were not available for the MADs.
No washout period between the change of treatment modality.
Low number of patients with severe sleep apnea who were free of co-morbidities.

Abstract

PURPOSE: The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy (CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial. METHODS: Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min. RESULTS: Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode. CONCLUSIONS: These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.

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