Respiratory and Cardiovascular Parameters Evaluation in OSA Patients Treated with Mandibular Advancement Device

Ciavarella Domenico,Cazzolla Angela Pia,Suriano Carmela,Tepedino Michele,Laurenziello Michele,Ferrara Donatella,Illuzzi Gaetano,Cassano Michele,Burlon Giuseppe

doi:10.3390/app10228175

Ciavarella Domenico, Cazzolla Angela Pia + Show 7 more

Open Access

https://doi.org/10.3390/app10228175

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Journal: Applied sciences	Publication Date: Nov 18, 2020
Citations: 5	License type: CC BY 4.0

Affiliation: University of Foggia, University of L'Aquila

Abstract

Obstructive sleep apnea (OSA) is associated with a number of cardiovascular comorbidities, including hypertension, heart rate (HR) alterations, cardiac arrhythmias, endothelial dysfunction and atherosclerosis. HR, in particular, is an important sign correlated with cardiac stress and survival. Previous investigations on the effects of mandibular advancement device (MAD) therapy on HR resulted in contradictory findings. The aim of the present retrospective cohort study was to evaluate the effects of MAD therapy with a fully customizable appliance on respiratory and cardiovascular parameters. Fifty adult consecutive cases with mild to severe OSA underwent split-night polysomnography (SN-PSG) at baseline (T0) and after three months of MAD treatment (T1), after appropriate titration. The apnea/hypopnea index (AHI), 4% oxygen desaturation index (ODI) and HR (average, minimum and maximum) values are recorded at T0 and at T1 and statistically compared. The AHI and ODI values improved after three months of MAD treatment. The minimum HR increased after treatment, while the maximum HR decreased after treatment. MAD treatment with a fully customizable appliance was effective in improving breathing and cardiovascular parameters in adult patients with mild to severe OSA.

Highlights

Obstructive sleep apnea (OSA) in adults is a condition with a high public health impact [1].OSA is characterized by recurring episodes of cessation or reduction in airflow during sleep caused by obstruction of the upper airway [2]
The intermittent hypoxia caused by the apnea/hypopnea events initiates a sequence of systemic alterations, including activation of the sympathetic nervous system, systemic inflammation, oxidative stress, endothelial dysfunction and atherosclerosis [9,10,11,12]
Several studies have reported the presence of common comorbidities with OSA, such as cardiovascular disease (CVD), cognitive impairment, psychiatric problems, diabetes and obesity, the etiopathogenesis pathway is not completely understood, it is not clear if a condition is a consequence of OSA or a risk factor [31]

Summary

Introduction

Obstructive sleep apnea (OSA) in adults is a condition with a high public health impact [1]. OSA is characterized by recurring episodes of cessation (apnea) or reduction (hypopnea) in airflow during sleep caused by obstruction of the upper airway [2]. The sleep arousal caused by OSA induces excessive daytime sleepiness (EDS) [5], increases the occurrence of driving accidents [6], induces reductions in concentration in both adults and children [7] and induces sleep fragmentation, which in some cases may induce depression [8]. The intermittent hypoxia caused by the apnea/hypopnea events initiates a sequence of systemic alterations, including activation of the sympathetic nervous system, systemic inflammation, oxidative stress, endothelial dysfunction and atherosclerosis [9,10,11,12].

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