http://www.ihateheadaches.org/

Patient describes 5 years of sleep apnea treatment with oral appliance. He initially used the CPAP machine but found it made him uncomfortable. Both him and his wife are able to get restful sleep. 


WATCH THE VIDEO: https://www.youtube.com/watch?v=WS00Pem3BF4


Visit http://www.thinkbetterlife.com to learn how we can use neuromuscular dental techniques to help with your sleep apnea and snoring. Sleep disorders often result in fatigue, trouble concentrating, memory loss, relationship problems, a decrease in job performance, among other effects. Simple dental devices are available to help you stop snoring, breath right, and get the sleep you need. We are located in Chicago, Illinois.

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Transcript: 

Dr. Shapira: Okay. John, tell me about your experience with the sleep appliance.

John: Yes, doctor. This has been absolutely phenomenal. I’ve got very severe sleep apnea and the thought of wearing a CPAP, I mean, just was a total turn off. I tried it one time and. I mean, it just gagged me and it was just really uncomfortable. So we tried a couple different appliances and the one I’m using right now works just absolutely phenomenal. My wife can get sleep, I can get sleep and it works just so much better than the CPAP machine ever did.

Dr. Shapira: Great. How long have you been using an appliance?

John: Oh, I’d have to think. It’s been at least five years.

Dr. Shapira: Okay. Is it okay if I post this on the website?

John: Absolutely.

Dr. Shapira:Great. Anything else you’d like to tell people about: treatment you’ve had from me?

John:Doctor, you’re just absolutely phenomenal. I can’t believe all of the care that 
you’ve given and all the help and your patience. I know that I’ve been a difficult patient because we’ve kind of pushed the limits with the appliance and I’m so glad you were willing to give it a try because I think it works really well.

Dr. Shapira: Great. Thank you very much John.

Visit these websites for more information or to make an appointment with Dr Shapira. www.ThinkBetterLife.com
www.ihatecpap.com
www.delanydentalcare.com
www.sleepandhealth.com
www.northshoresleepdentist.com

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org

"I used to fall asleep driving!" Oral Appliance Therapy to treat sleep apnea has changed my life!

Lake Forest Sleep Apnea Treatment:




Sleep Apnea patient describes how wearing a sleep apnea appliance for the last 6-7 years has drastically improved his sleep and his health. www.ThinkBetterLife.com

Watch the video:  https://www.youtube.com/watch?v=d4R4xYs_tAE

He recommends people with snoring or sleep apne a to have it treated and tells of his experiences with Dr Shapira and an oral appliance

Visit these websites for more information or to make an appointment with Dr Shapira.
www.ihatecpap.com

www.ThinkBetterLife.com

www.delanydentalcare.com
www.sleepandhealth.com
www.northshoresleepdentist.com

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org

Oral appliance treatment amazing according to sleep apnea patient

Mike describes how he was diagnosed with sleep apnea. He was less than thrilled with diagnosis and definitely did not want CPAP. He travels a lot and CPAP would be a problem. Besidesmhe definitely did not want CPAP and wanted a Comfortable CPAP Alternative. 
He cam to see Dr Shapira and received an oral appliance that he considers amazing therapy. He responded wonderfully to the oral appliance. Everything about the entire experience was wonderful and Dr Shapira's team is amazing.

Watch the Video:


https://www.youtube.com/watch?v=xYjNUxwwIOY

Skleep Apnea Treatment with Oral Appliance is Amazing!

Visit Dr Shapira's website to learn more:

Highland Park: www.ThinkBetterLife.com

Gurnee: www.DelanyDentalCare.com

North Shore www.NorthShoreSleepDentist.com

Hate CPAP? www.IHateCPAP

Hate Headaches? www.IHateHeadaches.org

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org


https://www.youtube.com/watch?v=xYjNUxwwIOY

Physician Did Not Want To Wear CPAP. Oral Appliance Working Well For Several Years

Physician Did Not Want To Wear CPAP. Oral Appliance Working Well For Several Years 

See The Video:  https://www.youtube.com/watch?v=B3kPBSzTjTQ

Sleep Apnea Treatment:  Oral Appliance Testimonial 

Tap Appliance and now Micro O2 appliance

Bill has worn the TAP 1 appliance for several years and loved it.
His od appliance is working great and is worn on a daily basis but was interested is seeing other types of appliances. He started with the MICRO O2 appliance and is very pleased.

There are many new appliances available and the Micro is one of the easies to keep clean and maintain. It is cadcam manufactured leading to a very high quality composition ideal for patients with chemocal sensitivities or allergies.

The TAP 1 appliance is considered the single most effective appliance due to design and ease of titration. Titration is the fine tuning of an appliance to eliminate residual apneas. TAP 1 treatment is ideal for the most severe apneic patients. Once apnea is well controlled and the final positions been titrated patients can change appliances to their personal preferences.

The SomnoDent Appliance by Somnomed has a stronger and more versatile new version. The new Dream TAP is ideal for heavy bruxers and clenches and has a very wide range of adjustments.

The Micro O2 is actually a system of CAD-Cam manufactured appliances in multiple adjustment levels that gradually move the mandible foward by a series of different appliances.

This Chicago Sleep Apnea Testimonial is only one of the thousands of patients Dr Shapira has treated over the last 35 years vastly improving quality of life.

Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org
www.SleepandHealth.com
www.SphenopalatineGanglionBlocks.com
www.northshoresleepdentist.com

Headaches, TMJ and Neuromuscular Dentistry: TMJ Testimonial Videos

The neuromuscular approach to treating TMJ Disorders is extremely effective because the use of ULF-TENS relaxes the muscles at the start of treatment and periodically throughout treatment.

Many dentists feel that Neuromuscular Dentistry is cheating because using the TENS to create healthy muscles makes it much easier to treat patients. wThe goal of neuromuscular dentistry is not just to relax the muscles and create a healthy physioogy within the muscles but also to create a closure position that allows those muscles to reset to that healthy position after each and every closure.

Experienced Neuromuscular Dentists understand that each and every patient is unique and adjust their treatment to suit each patient.

The Mandibular Kinesiograph or Computerized mandibular scan is a diagnostic instrument that lets the experienced neuromuscular dentist see exactly what is happening during function.  While other dentists guess neuromuscular dentists use precision measurements during their diagnosis process.  This process continues throughout treatment.  After delivery of the diagnostic orthoic there are postural changes throughout the body.  The jaw position is repeatedly verified throughout treatment.

It is impossible to take a perfect bite in a patient with muscle shortening, spasm or myofascial pain in a single visit.  It is actually a gradual process but sometimes seems magical.

In addition to the neuromuscular diagnostic orthotic additional treatments may include Sphenopalatine Ganglion (SPG) Blocks, Spray and Stretch, Trigger Point injections and many types of home care patients are taught.  The ultimate goal is to creat patients who no longer have TMJ problems or who have long term stable solutions.

This video is during the first visit of a patient who has suffered horribly severe pain her whole life.  https://www.youtube.com/watch?v=n7fQKStzAUo&t=2s

The next video is a patient who suffered for 12 years and was told she needed massive surgery to fix her problems.  This video is 1 year after treatment was complete.  She now only comes in for yearly checks.  https://www.youtube.com/watch?v=cLwX6xXLc0I

The next patient had problems for 25 years and was told surgery was needed.  https://www.youtube.com/watch?v=c1qdCHNB0F8&t=3s

Brooklynn is near the beginning of her treatment but has already experienced massive improvement.


There are over 100 TMJ Testimonials on the Think Better Life Youtube channel. Neuromuscular Dentistry and the Treatment of TMJ disorders and sleep disorders.  Most TMJ and Sleep patients have many similarities in jaw issues, just different symptoms.  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/featured

Dr Shapira treats TMJ and Sleep Disorder patients in his Highland Park office.  www.thinkBetterLife.com

In Gurnee at Delany Dental Care   www.DelanyDentalCare.com

Learn more about sleep apnea treatment at www.IHateCPAP.com

In Chicago www.NorthShoreSleepDentist.com

Chicago: Sleep Apnea Patients Love Oral Appliance Therapy

Video Testimonials are an excellent way to understand what an Oral Appliance can do for you.

These are just a few of the happy patients now using oral appliances instead of CPAP.

Hear them explain how their lives have been improved treating difficult sleep apnea with a comfortable oral appliance instead of CPAP.




15 years Experience with Oral appliance experiences. Better than CPAPl

https://www.youtube.com/watch?v=haxLDg8ZZfA

Physician Did Not Want To Wear CPAP. Oral Appliance Working Well For Several Years
https://www.youtube.com/watch?v=B3kPBSzTjTQ


Severe Apnea treated with TAP 1 oral appliance for 3 years. "I LOVE IT!"
https://www.youtube.com/watch?v=Tq8F_kQf_eI


Sleep apnea patient Larry wearing sleep appliance 10 years
https://www.youtube.com/watch?v=zpxGYFW175s


Living in Fog before Sleep Appliance. Wearing TAP since 2007
https://www.youtube.com/watch?v=lxRtjXJMJ1k

WALL STREET NEWS.... Sleep Apnea Treatment: CPAP and Oral Appliances are Equivalent

Symbol Lookup Wednesday, April 13th 2016 5:10pm ET - U.S. markets closed. Nasdaq      +75.33 4947.42 +1.55%   NYSE      +0.00 10359.51 +0.00   AMEX      -0.72 2280.02 -0.03%   S&P 500      +20.70 2082.42 +1.00%

Sleep Apnea Treatment: CPAP and Oral Appliances are Equivalent According to Outcome Studies. Patients Prefer Comfortable Oral Appliance to CPAP Chicago Dentist Leader in Oral Appliance Therapy
Oral Appliances are preferred over by 95% of patients with Sleep Apnea yet CPAP is usually prescribed even in mild and moderate sleep apnea when outcomes are equal. Patient Testimonials say it all! Do CPAP Companies Pay Kickbacks to promote CPAP?

CHICAGO, IL, April 09, 2016 /24-7PressRelease/ -- Treatment of sleep apnea is essential. CPAP was once considered the Gold Standard of Care but today Oral Appliances are considered a First Line Approach equal to CPAP for mild to moderate Sleep Apnea and an alternative for severe apnea when the patient does not tolerate or prefers oral appliance therapy. 

Patients generally don't like CPAP, in fact only 25% use CPAP as recommended but 60% abandon it completely. The number one reason patients give why they discontinue CPAP use "I Hate CPAP!"

Millions of patients have visited www.IHateCPAP.com looking for comfortable alternatives to CPAP. Marketing of this site at AASM and AADSM meetings was banned even though it was acknowledged it would save lives of non-compliant CPAP patients. 

Dr Ira Shapira is a Chicago area dentist who has been treating sleep apnea with oral appliances since 1982. The American Academy of Dental Sleep Medicine is celebrating it's 25th Anniversary in June in Denver. Dr Shapira was one of 20 dentists worldwide who started the Sleep Disorder Dental Society 25 years ago that became today's American Academy of Sleep Medicine. Dr Shapira created the I Hate CPAP website that brought oral appliances into the mainstream and was featured on numerous Television and Radio news stations as well as publications like Bottomline.

The Science of Sleep Medicine has given it's verdict: Oral Appliances are safe and effective for mild, moderate and severe sleep apnea.

Outcome studies for cardiac, blood pressure and cognitive measures are equal and sometimes oral appliances rate higher than CPAP.

A new article in JAMA states that outcome studies of CPAP and Oral Appliances are similar. Another article in Sleep and Breathing Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. This article concluded that "that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure." 

Oral Appliances continually prove to be equal to CPAP in OUTCOME STUDIES. This is in spite of the fact that the majority of research money funds studies to show value of CPAP and that CPAP companies expect a return on their investment.

The conclusions of this study are enormous, Among patients with obstructive sleep apnea, both CPAP and MADs (mandibular advancement devices) were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.

Another article in Respirology, "Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study" concluded "Both CPAP and MAD may be equally effective therapy in reducing the risk of fatal cardiovascular events in patients with severe OSA."

The Sleep and Breathing article also stated that "CPAP is more effective than MAD in eliminating respiratory events." While this is true other studies have shown that the frequency and length of use of oral appliances actually makes total effectiveness higher. Most CPAP users only utilize CPAP 30-40% of the time. 

A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study. (Oral Dis. 2015 Apr;21(3):386-92.) concluded that "Oral appliances were found to be successful for treating for severe OSA after first-line treatment had failed."

The DNA Appliance (an oral appliance) has been shown to orthopedically grow the airway in a process called Pneumopedics and has been shown in clinical cases to "Cure" Sleep Apnea. Long term prospective studies are beginning.

CPAP continues to be prescribed far more than oral appliances. Much of this is due to doctors who are ignorant of newest studies or who like CPAP and ignore the research. There is also a problem with billions of dollars in Revenue allowing CPAP companies to push their product, often using unethical practices.

A recent lawsuit found " Philips Respironics has agreed to pay $34.8 million to resolve alleged False Claims Act violations for paying kickbacks to DME providers that bought its CPAP masks, the Department of Justice has announced."

There are many in the field of sleep medicine who feel this is only the tip of the iceberg and that illegal or unethical marketing may be widespread.

"The payment of illegal remuneration in any form to induce patient referrals threatens public confidence in the healthcare system," said Principal Deputy Assistant Attorney General Benjamin Mizer, head of the Justice Departments' Civil Division. "Americans deserve to know that when they are prescribed a device to treat a serious healthcare problem, they supplier's judgment has not been compromised by illegal payments from equipment manufacturers." 

The Anti-Kickback Statute prohibits the knowing and willful payment of any remuneration to induce the referral of services or items that are paid for by a federal healthcare program, such as Medicare, Medicaid or Tricare. Claims submitted to these programs in violation of the Anti-Kickback Statute are also false claims under the False Claims Act.

Respironics will pay roughly $34.14 million to the federal government and roughly $660,00 to various state governments based on their participation in the Medicare program.

The field of Dental Sleep Medicine grew based on patient referrals and testimonials not by illegal kickbacks. In the following youtube testimonials patients clearly explain why they prefer oral appliances to other treatments.

Think Better Life - Dr. Ira Shapira
35 YEARS OF SLEEP APNEA TREATMENT. VIEW THIS VIDEO OF A PATIENT WEARING AN ORAL APPLIANCE FOR 9 YEARS.
https://www.youtube.com/watch?v=1WsNhOE0wvw

ANOTHER PATIENT WITH 9 YEARS EXPERIENCE
https://www.youtube.com/watch?v=Cub9IROYoYY

A FEMALE PATIENT USING ORAL APPLIANCE
https://www.youtube.com/watch?v=0BxuX9Yso1I

USED TO FALL ASLEEP DRIVING
https://www.youtube.com/watch?v=d4R4xYs_tAE

ORAL APPLIANCE FOR INTERNATIONAL TRAVEL
https://www.youtube.com/watch?v=6VNsb6n8mXw

PHYSICIAN REVIEWS SLEEP APNEA APPLIANCE.
https://www.youtube.com/watch?v=aMp64bXi9bI

RESPIRATORY THERAPIST REVIEWS APPLIANCE
https://www.youtube.com/watch?v=f9w9L1miIN4

Dentist helps with sleep apnea, snoring, and fibromyalgia
https://www.youtube.com/watch?v=kMEhJemCwm8

ADNA Appliance Testimonial...Life Changing results!!!
https://www.youtube.com/watch?v=j9Y7EPf9tiM

ADDITIONAL VIDEOS ON SLEEP, TMJ TREATMENT, MIGRAINE TREATMENT , CHRONIC DAILY HEADACHES AND MORE
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

Learn More at www.IHateCPAP.com

In Highland Park and surrounding suburbs Visit:
www.ThinkBetterLife.com

In Gurnee and Far North Suburbs:
www.DelanyDentalCare.com

North Shore visit:
www.NorthShoreSleepDentist.com

#sleepapneadentist, #snoringcure, #Oralappliance, #oralappliancetherapy, #sleeptreatment, #snoringtreatment, #apneatreatment, #sleeptestimonial, #snoringtestimonial, #guneesnoring, #gurneesleepapnea, #Dentalsleepmedicine, #academyofdentalsleepmedicine

Dr Ira L Shapira created the I HATE CPAP (www.ihatecpap.com) and I HATE HEADACHE (www.ihateheadaches.org) websites to help patients find help with these difficult medical disorders that medicine can frequently not treat adequately without a dental collaboration. Dr Shapira did research in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a Diplomate of the American Academy of Pain Management, and a Fellow of the International College of CranioMandibular Orthopedics (ICCMO). He is a former national and International Regent of ICCMO, its current Secretary and the representative to the Alliance of TMD organizations or the TMD ALLIANCE has a general dental practice (http://www.delanydentalcare.com) in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates with offices in Vernon Hills and Highland Park. Patients in Northern Illinois or southern Wisconsin can contact Dr Shapira thru his office websites or thru http://www.ihateheadaches.org or http://www.chicagoland.ihatecpap.comwww.ThinkBetterLife.com, NorthShoreSleepDentist.com SleepandHealth.com

Dr Ira L Shapira is President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice, Delany Dental Care with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative and the current Chair of the American Alliance of TMD Organizatins (www.TMDAlliance.com), He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of the fields of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com

Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. He is currently working with Dr Tom Diekwisch at the Baylor in Texas to prove these stem cells can change peoples lives for the better. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

Dr Shapira is currently working on patents he hope will drastically improve the field of pain management.

---

Oral Appliance Therapy in Sleep Apnea Patients Improve Cognitive and Psychomotor Performance

This new study in the Journal of Clinical Sleep Medicine shows improvement in cognitive function in patients with sleep apnea.

Other recent outcome studies have shown improvement in Blood Pressure and Cardiac Function.

Review these abstracts and you will understand why more and more sleep physicians consider oral appliances to be a first line treatment for moderate obstructive sleep apnea and an alternative for severe sleep apnea.

Find oral Appliance Therapy in Chicago:

www.IHateCPAP.com   find a dentist section

www.ThinkBetterLife.com

www.DelanyDentalCare.com

www.NorthShoreSleepDentist

J Clin Sleep Med. 2015 Feb 15;12(2):177-86. doi: 10.5664/jcsm.5480.

Improvement of Cognitive and Psychomotor Performance in Patients with Mild to Moderate Obstructive Sleep Apnea Treated with Mandibular Advancement Device: A Prospective 1-Year Study.

Galic T1, Bozic J2, Pecotic R3,4, Ivkovic N3, Valic M3,4, Dogas Z3,4.

Author information

Abstract

STUDY OBJECTIVES:

This study aimed to provide the evidence on effect of mandibular advancement device (MAD) therapy on long-term cognitive and psychomotor performance, excessive daytime sleepiness, and quality of life in patients with mild to moderate obstructive sleep apnea (OSA).

METHODS:

A total of 15 patients with mild to moderate OSA were treated with MAD therapy and they were followed up after 3 mo and 1 y oftherapy. The patients were tested on three different tests of cognitive and psychomotor performance using the computer-based system Complex Reactionmeter Drenovac (CRD-series) at baseline and at the time of follow-up, and the 36-Item Short Form Health Survey (SF-36) questionnaire and Epworth Sleepiness Scale were used to assess their quality of life and excessive daytime sleepiness, respectively.

RESULTS:

The mean apnea-hypopnea index (AHI) decreased significantly from 22.9 ± 5.9 events/h at baseline, to 9.7 ± 4.5 events/h after 1 y ofMAD therapy (p < 0.001). There was significant improvement on all three CRD-series tests used after 1 y of MAD therapy, considering total test solving time (TTST) and minimal single task solving time (MinT), whereas total number of errors committed during the tests (TE) remained unchanged. Self-reported measures, excessive daytime sleepiness, and three domains of quality of life, social functioning, general health perception, and health change following MAD therapy showed significant improvements after 1 y of MAD therapy.

CONCLUSIONS:

This study demonstrates significant improvements in cognitive and psychomotor performance, particularly in the domain of perceptive abilities, convergent thinking (constructing and solving simple mathematical tasks) and psychomotor reaction times, excessive daytime sleepiness, and quality of life in patients with mild to moderate OSA following MAD therapy.

JAMA. 2015 Dec 1;314(21):2280-93. doi: 10.1001/jama.2015.16303.

CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Bratton DJ1, Gaisl T1, Wons AM1, Kohler M2.

Author information

Abstract

IMPORTANCE:

Obstructive sleep apnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk.

OBJECTIVE:

To compare the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), and inactive control groups (placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP) in patients with obstructive sleep apnea.

DATA SOURCES:

The databases of MEDLINE, EMBASE, and the Cochrane Library were searched up to the end of August 2015 and study bibliographies were reviewed.

STUDY SELECTION:

Randomized clinical trials comparing the effect of CPAP or MADs (vs each other or an inactive control) on BP in patients with obstructive sleep apnea were selected by consensus. Of 872 studies initially identified, 51 were selected for analysis.

DATA EXTRACTION AND SYNTHESIS:

Data were extracted by one reviewer and checked by another reviewer. A network meta-analysis using multivariate random-effects meta-regression was used to estimate pooled differences between each intervention. Meta-regression was used to assess the association between trial characteristics and the reported effects of CPAP vs inactive control.

MAIN OUTCOMES AND MEASURES:

Absolute change in SBP and DBP from baseline to follow-up.

RESULTS:

Of the 51 studies included in the analysis (4888 patients), 44 compared CPAP with an inactive control, 3 compared MADs with an inactive control, 1 compared CPAP with an MAD, and 3 compared CPAP, MADs, and an inactive control. Compared with an inactive control, CPAP was associated with a reduction in SBP of 2.5 mm Hg (95% CI, 1.5 to 3.5 mm Hg; P < .001) and in DBP of 2.0 mm Hg (95% CI, 1.3 to 2.7 mm Hg; P < .001). A 1-hour-per-night increase in mean CPAP use was associated with an additional reduction in SBP of 1.5 mm Hg (95% CI, 0.8 to 2.3 mm Hg; P < .001) and an additional reduction in DBP of 0.9 mm Hg (95% CI, 0.3 to 1.4 mm Hg; P = .001). Compared with an inactive control, MADs were associated with a reduction in SBP of 2.1 mm Hg (95% CI, 0.8 to 3.4 mm Hg; P = .002) and in DBP of 1.9 mm Hg (95% CI, 0.5 to 3.2 mm Hg; P = .008). There was no significant difference between CPAP and MADs in their association with change in SBP (-0.5 mm Hg [95% CI, -2.0 to 1.0 mm Hg]; P = .55) or in DBP (-0.2 mm Hg [95% CI, -1.6 to 1.3 mm Hg]; P = .82).

CONCLUSIONS AND RELEVANCE:

Among patients with obstructive sleep apnea, both CPAP and MADs were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.

Sleep Breath. 2015 Oct 13. [Epub ahead of print]

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

Glos M1, Penzel T2, Schoebel C2, Nitzsche GR2, Zimmermann S2, Rudolph C2, Blau A2, Baumann G3, Jost-Brinkmann PG4, Rautengarten S5, Meier JC4, Peroz I5, Fietze I2.

Author information

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.

KEYWORDS:

Baroreceptor sensitivity; Blood pressure; Cardiac autonomic function; Continuous positive airway pressure; Heart rate variability; Mandibular advancement device; Obstructive sleep apnea

PMID:

 

26463420

 

[PubMed - as supplied by publisher]