HYPERTENSION, SLEEP APNEA AND CPAP COMPLIANCE. ORAL APPLIANCES ARE A CPAP ALTERNATIVE.

AN ARTICLE IN CHEST JOURNAL LOOKS AT SLEEP AND HYPERTENSION. According to the August 2010 article in Chest "even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality.". This increase in in Blood pressure "sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension.is related to many types of sleep disorders including restless legs "sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension".

Patients with sleep apneathe article states "observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence."

The problem is that CPAP compliance is poor or non-existent for the majority of patients. Due to the severe problems that can result from untreated sleep apnea more and more concerned and compassionate cardiologists and internists are turning to Oral Appliances and Dental Sleep Medicine as the Best Sleep Apnea Treatment for their patients that do not tolerate CPAP.

There is no question that CPAP therapy is very effective when it is used. There is also no longer a belief that most patients will tolerate CPAP. Because non adherence and non-compliance is the rule not the exception in sleep apnea treatment the question about "What is the Best Sleep Apnea Treatment?" is still open.

Chest. 2010 Aug;138(2):434-43.
Sleep and hypertension.
Calhoun DA, Harding SM.

Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-1150, USA. dcalhoun@uab.edu
Abstract
Ambulatory BP studies indicate that even small increases in BP, particularly nighttime BP levels, are associated with significant increases in cardiovascular morbidity and mortality. Accordingly, sleep-related diseases that induce increases in BP would be anticipated to substantially affect cardiovascular risk. Both sleep deprivation and insomnia have been linked to increases in incidence and prevalence of hypertension. Likewise, sleep disruption attributable to restless legs syndrome increases the likelihood of having hypertension. Observational studies demonstrate a strong correlation between the severity of obstructive sleep apnea (OSA) and the risk and severity of hypertension, whereas prospective studies of patients with OSA demonstrate a positive relationship between OSA and risk of incident hypertension. Intervention trials with continuous positive airway pressure (CPAP) indicate a modest, but inconsistent effect on BP in patients with severe OSA and a greater likelihood of benefit in patients with most CPAP adherence. Additional prospective studies are needed to reconcile observational studies suggesting that OSA is a strong risk factor for hypertension with the modest antihypertensive effects of CPAP observed in intervention studies.

PMID: 20682533 [PubMed - indexed for MEDLINE]PMCID: PMC2913764 [Available on 2011/8/1

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

WELL IT IS WELL ESTABLISHED THAT ORAL APPLIANCES ARE EFFECTIVE IN TREATING SLEEP APNEA AND SNORING THIS ARTICLE SHOWS IT ALSO REDUCES BLOOD PRESSURE SIMILAR TO CPAP TREATMENT.

HEAVY SNORING HAS BEEN SHOWN TO INCREASE CAROTID ATHEROSCLEROSIS DUE TO VIBRATIONS. THIS IS ALSO WELL TREATED BY ORAL APPLIANCE THERAPY.

IF SLEEP APNEA IS ELIMINATED THAN THE DISORDERS RELATED TO THE DISORDER WILL ALSO BE ELIMINATED. I EXPECT THAT RESEARCH WILL CONTINUE TO SHOW THAT ORAL APPLIANCES ARE EQUAL TO CPAP WHEN SLEEP APNEA IS SUCCESSFULLY TREATED.

BECAUSE 60% OF PATIENTS ABANDON CPAP IT IS INEFFECTIVE FOR THOSE PATIENTS. SIMPLY STATED CPAP DOES NOT SUCCESSFULLY TREAT ANY DISORDERS IN THE 60% OF PATIENT WHO DO NOT USE IT.

WHAT IS THE BEST SLEEP APNEA TREATMENT? THE BEST SLEEP APNEA TREATMENT IS BOTH EFFECTIVE AND IS USED BY PATIENTS.

THE BEST TREATMENT WILL ALWAYS BE A TREATMENT THAT IS USED BY THE PATIENT. COMFORTABLE ORAL APPLIANCES ARE PREFERRED OVER CPAP BY MOST PATIENTS OFFERED A CHOICE.

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.