Mandibular advancement device and CPAP upon cardiovascular parameters in OSA

Mandibular advancement device and CPAP upon cardiovascular parameters in OSA

Author Dal-Fabbro, Cibele Autor UNIFESP Google Scholar
Garbuio, Silvério Aparecido Autor UNIFESP Google Scholar
D'Almeida, Vania Autor UNIFESP Google Scholar
Cintra, Fatima D. Autor UNIFESP Google Scholar
Tufik, Sergio Autor UNIFESP Google Scholar
Bittencourt, Lia Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract This study aims to compare the effects of a mandibular advancement device (MAD) with continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP), oxidative stress, and heart rate variability (HRV) in a randomized, crossed-over, single-blind, and controlled trial.Twenty-nine moderate-to-severe adult OSA patients underwent MAD, CPAP, and placebo oral appliance treatment. Polysomnography, Epworth sleepiness scale, 24-h ambulatory BP monitoring, oxidative stress parameters (malondialdehyde, catalase, superoxide dismutase, vitamins C, E, B-6, B-12, folate, homocysteine, uric acid), and HRV were assessed at baseline and after 1 month of each treatment. Diaries were used to evaluate compliance for devices and a pressure-time meter for CPAP.Both active treatments resulted in decreases in apnea and hypopnea index and Epworth sleepiness scale; CPAP showed a greater effect. Frequency of diastolic BP dipping was higher in the MAD group compared with the CPAP group. A significant drop from baseline levels for catalase activity was observed after MAD. for HRV, there was a significant decrease in total power at night with CPAP and MAD compared with POA, and a decrease in index of sleep autonomic variation with MAD compared with baseline levels. Compliance rates were higher with MAD rather than CPAP.Even though CPAP proved to be more effective at attenuating OSA, better compliance with MAD favored the reduction of one of the enzymes which participates in oxidative stress and better autonomic modulation during sleep.
Keywords Mandibular advancement device
Obstructive sleep apnea
Continuous positive airway pressure
Heart rate variability
Oxidative stress
Blood pressure
Language English
Sponsor Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Grant number CNPq: 47.4277/2004-6
Date 2014-12-01
Published in Sleep and Breathing. Heidelberg: Springer Heidelberg, v. 18, n. 4, p. 749-759, 2014.
ISSN 1520-9512 (Sherpa/Romeo, impact factor)
Publisher Springer
Extent 749-759
Origin http://dx.doi.org/10.1007/s11325-014-0937-5
Access rights Closed access
Type Article
Web of Science ID WOS:000344784800012
URI http://repositorio.unifesp.br/handle/11600/38498

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