Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea

Hasthi U Dissanayake; Kate Sutherland; Craig L Phillips; Ronald R Grunstein; Anastasia S Mihailidou; Peter A Cistulli

doi:10.1016/j.sleep.2021.01.059

Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea

Sleep Med. 2021 Apr:80:294-300. doi: 10.1016/j.sleep.2021.01.059. Epub 2021 Feb 3.

Authors

Hasthi U Dissanayake¹, Kate Sutherland², Craig L Phillips³, Ronald R Grunstein⁴, Anastasia S Mihailidou⁵, Peter A Cistulli²

Affiliations

¹ Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia. Electronic address: hasthi.dissanayake@sydney.edu.au.
² Sleep Research Group, D 17 - Charles Perkins Centre, The University of Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia; Centre for Sleep Health & Research, Department of Respiratory Medicine, Royal North Shore Hospital, Australia.
³ Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia.
⁴ Faculty of Medicine and Health, Sydney Medical School, Northern Clinical School, The University of Sydney, Australia; Woolcock Institute of Medical Research, Sydney, Australia.
⁵ Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.

PMID: 33610954
DOI: 10.1016/j.sleep.2021.01.059

Abstract

Background: Obstructive sleep apnoea (OSA) is associated with increased blood pressure variability (BPV) and are risk factors for cardiovascular disease. We aimed to assess the comparative effects of two OSA therapies, continuous positive airway pressure (CPAP) and mandibular advancement splint (MAS), on BPV.

Methods: This is a secondary analysis of data collected as part of a previously published randomised crossover trial of one month each of CPAP and MAS therapy. BPV was determined from 24-h-ambulatory blood pressure recordings in 92 patients with moderate to severe OSA at baseline and after one month of optimised treatment with each modality. BPV was assessed by three measures: Standard deviation of the mean (SD), Coefficient of variation (CoV), and the Average Real Variability (ARV) index.

Results: Neither CPAP nor MAS therapy improved BPV, with no difference between treatments. BPV did not change in hypertensive OSA patients, however, there was a reduction in ARV of diastolic blood pressure in the effectively treated compared to ineffectively treated CPAP patients, Δ ARV 24-h-DBP (mmHg), -0.72 ± 2.14, 0.34 ± 1.52, P = 0.02, respectively. There was no difference between effective versus ineffective MAS treatment, Δ ARV 24-h-DBP (mmHg), -0.04 ± 2.4, 0.02 ± 1.9, P = 1.00, respectively.

Conclusions: One month of optimised CPAP or MAS therapy did not improve short term BPV in patients with moderate to severe OSA. The subgroup of patients on effective CPAP showed some improvement in BPV with CPAP but not MAS. Further work on the effect of OSA therapy on BPV following long-term therapy is needed.

Keywords: Blood pressure variability; Continuous positive airway pressure; Mandibular advancement splint; Obstructive sleep apnoea.

Publication types

Randomized Controlled Trial

MeSH terms

Blood Pressure Monitoring, Ambulatory
Blood Pressure*
Continuous Positive Airway Pressure*
Cross-Over Studies
Humans
Mandibular Advancement*
Occlusal Splints*
Sleep Apnea, Obstructive* / therapy