ORAL APPLIANCES TREATING SLEEP APNEA REDUCE BLOOD PRESSURE SIMILAR TO CPAP.

A FREQUENT QUESTION IS WHETHER SLEEP APNEA IS BEST TREATED WITH CPAP OR ORAL APPLIANCES. ARE THE MEDICAL RESULTS AS EFFECTIVE WITH ORAL APPLIANCES? THE RESEARCH SAYS ORAL APPLIANCES ARE AS EFFECTIVE AS CPAP IN REDUCING SYMPTOMS WHEN IT IS USED EFFECTIVELY.

THE BEST SLEEP APNEA TREATMENT IS ONE THAT IS USED ON A REGULAR BASIS. IT IS WELL ESTABLISHED THAT CPAP FAILS THE MAJORITY OF PATIENTS DUE TO COMPLIANCE ISSUES. WHEN COMPLIACE IS FACTORED INTO TREATMENT EFFECTIVENESS ORAL APPLIANCES ARE THE MOST EFFECTIVE AND BEST TREATMENT OF MILD TO MODERATE SLEEP APNEA. ORAL APPLIANCE EFFICACY MUST BE CONFIRMED BY OVERNIGHT POLYSOMNOGRAPHY.

CARDIOLOGISTS ARE RECOGNIZING THAT CPAP TYHERAPY IS INEFFECTIVE IN MOST PATIENTS DUE TO POOR COMPLIANCE.

Sleep. 2004 Aug 1;27(5):934-41.
Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial.

Gotsopoulos H, Kelly JJ, Cistulli PA.
Department of Respiratory & Sleep Medicine, St George Hospital, The University of New South Wales, Sydney Australia.
Comment in:
Sleep. 2004 Aug 1;27(5):842-3.

Abstract

STUDY OBJECTIVE: To investigate the short-term effect (4 weeks) of oral appliance therapy for obstructive sleep apnea on blood pressure.
DESIGN: Randomized, controlled, crossover trial.
SETTING: Multidisciplinary sleep disorders clinic in a university teaching hospital.
PATIENTS: Sixty-one patients diagnosed with obstructive sleep apnea on polysomnography (apnea hypopnea index > or = 10 per hour and at least 2 of the following symptoms--daytime sleepiness, snoring, witnessed apneas, fragmented sleep; age > 20 years; and minimum mandibular protrusion of 3 mm).
INTERVENTION: A mandibular advancement splint (MAS) and control oral appliance for 4 weeks each.
MEASUREMENTS AND RESULTS: Polysomnography and 24-hour ambulatory blood pressure monitoring were carried out at baseline and following each 4-week intervention period. Patients showed a 50% reduction in mean apnea hypopnea index with MAS compared with the control and a significant improvement in both minimum oxygen saturation and arousal index. There was a significant reduction with the MAS in mean (+/- SEM) 24-hour diastolic blood pressure (1.8 +/- 0.5 mmHg) compared with the control (P = .001) but not in 24-hour systolic blood pressure. Awake blood-pressure variables were reduced with the MAS by an estimated mean (+/- SEM) of 3.3 +/- 1.1 mmHg for systolic blood pressure (P = .003) and 3.4 +/- 0.9 mmHg for diastolic blood pressure (P < .0001). There was no significant difference in blood pressure measured asleep.
CONCLUSION: Oral appliance therapy for obstructive sleep apnea over 4 weeks results in a reduction in blood pressure, similar to that reported with continuous positive airway pressure therapy