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Sleep Breath. 2016 May;20(2):635-46. doi: 10.1007/s11325-015-1265-0. Epub 2015 Oct 13.

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

Author information

1
Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany. martin.glos@charite.de.
2
Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
3
Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, CCM-CC11, Berlin, Germany.
4
Department of Dentofacial Orthopedics, Orthodontics, and Pedodontics, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.
5
Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.

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
PMCID:
PMC4850173
DOI:
10.1007/s11325-015-1265-0
[Indexed for MEDLINE]
Free PMC Article

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