Mandibular advancement device and CPAP upon cardiovascular parameters in OSA.
OBJECTIVE
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.


METHODS
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, B6, B12, 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.


RESULTS
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.


CONCLUSIONS
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.
Departamento de Psicobiologia, Universidade Federal de São Paulo - UNIFESP, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
Cibele
C
Dal-Fabbro
Silvério
S
Garbuio
Vânia
V
D'Almeida
Fátima D
FD
Cintra
Sergio
S
Tufik
Lia
L
Bittencourt
D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D003131:Combined Modality Therapy; D045422:Continuous Positive Airway Pressure; D018592:Cross-Over Studies; D006970:Disorders of Excessive Somnolence / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology*; D017286:Polysomnography; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D011795:Surveys and Questionnaires