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

Martin Glos,Sandra Zimmermann,Thomas Penzel,Jan Christian Meier,Gert Baumann,Alexander Blau,Stefanie Rautengarten,Ingrid Peroz,Ingo Fietze,Georg-Reiner Nitzsche,Christopher Rudolph,Christoph Schoebel,Paul-Georg Jost-Brinkmann

doi:10.1007/s11325-015-1265-0

Abstract

PurposeThe 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.MethodsForty 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.ResultsBoth 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.ConclusionsThese 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.

Highlights

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and affects about 5–7 % of the adult population [1]
The effects of 12-week continuous positive airway pressure therapy (CPAP) and 12week mandibular advancement therapy (MAD) therapy on cardiovascular and autonomic parameters during daytime were investigated, under conditions of controlled breathing. Both CPAP and MAD therapy led to changes in blood pressure in patients with mild to severe obstructive sleep apnea (OSA)
Changes in heart rate variability (HRV) values were observed for therapy with MAD

Summary

Introduction

Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing and affects about 5–7 % of the adult population [1]. Repetitive collapses of the upper airways during sleep lead to hypoxic phases with associated sleep fragmentation and sympathetic activation, the latter of which persists during daytime with the resultant consequences [2]. OSA has been confirmed as an independent cardiovascular risk factor that may increase mortality if left untreated [3]. Continuous positive airway pressure (CPAP) therapy is manifestly an effective therapeutic approach. Many studies have demonstrated that CPAP therapy reduces cardiovascular risk and overall mortality rate if regularly employed by OSA patients [2,3,4]. CPAP therapy is recommended as the standard therapy in moderate to severe OSA. The CPAP effect can partly be explained by its reduction of sympathetic tone during the night and during daytime [5]

Methods

Results

Conclusion