title: Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime.
abstract: OBJECTIVE
  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.
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany. martin.glos@charite.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Glos
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Penzel
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schoebel
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Georg-Reiner
authors.initials: GR
authors.lastname: Nitzsche
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Zimmermann
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rudolph
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Blau
authors.affiliation: Department of Cardiology and Angiology, Charité-Universitätsmedizin Berlin, CCM-CC11, Berlin, Germany.
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.affiliation: Department of Dentofacial Orthopedics, Orthodontics, and Pedodontics, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.
authors.forename: Paul-Georg
authors.initials: PG
authors.lastname: Jost-Brinkmann
authors.affiliation: Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Rautengarten
authors.affiliation: Department of Dentofacial Orthopedics, Orthodontics, and Pedodontics, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.
authors.forename: Jan Christian
authors.initials: JC
authors.lastname: Meier
authors.affiliation: Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité-Universitätsmedizin Berlin, CBF-CC3, Berlin, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Peroz
authors.affiliation: Center for Sleep Medicine, Charité-Universitätsmedizin Berlin, CCM-CC11, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Fietze
mesh_terms: D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002940:Circadian Rhythm / Q000502:physiology*; D045422:Continuous Positive Airway Pressure; D018592:Cross-Over Studies; D005260:Female; D006321:Heart / Q000294:innervation*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000628:therapy*
keywords: Baroreceptor sensitivity; Blood pressure; Cardiac autonomic function; Continuous positive airway pressure; Heart rate variability; Mandibular advancement device; Obstructive sleep apnea