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Randomized Controlled Trial
. 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

Free PMC article
Randomized Controlled Trial

Comparison of Effects of OSA Treatment by MAD and by CPAP on Cardiac Autonomic Function During Daytime

Martin Glos et al. Sleep Breath. .
Free PMC article


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.


Fig. 1
Fig. 1
Flow diagram of the study: T1 at the beginning of therapy, T2 after 12 weeks of initial therapy, and T3 after another 12 weeks with the following therapy
Fig. 2
Fig. 2
Effect of MAD and CPAP therapy on the apnea-hypopnea index (AHI) as determined by polysomnography (PSG)
Fig. 3
Fig. 3
Effect of MAD and CPAP therapy on three-minute mean values of continuous diastolic blood pressure recordings (BP-diast) under conditions of spontaneous breathing, breathing at 6/min, 12/min, and 15/min, from the daytime cardiac autonomic function test

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    1. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–1239. doi: 10.1164/rccm.2109080. - DOI - PubMed
    1. Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) Circulation. 2008;118:1080–1111. doi: 10.1161/CIRCULATIONAHA.107.189420. - DOI - PubMed
    1. Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–1053. doi: 10.1016/S0140-6736(05)74229-X. - DOI - PubMed
    1. Fava C, Dorigoni S, Dalle VF, Danese E, Montagnana M, Guidi GC, Narkiewicz K, Minuz P. Effect of CPAP on blood pressure in patients with OSA/hypopnea a systematic review and meta-analysis. Chest. 2014;145:762–771. doi: 10.1378/chest.13-1115. - DOI - PubMed
    1. Roche F, Court-Fortune, Pichot V, Duverney D, Costes F, Emonot A, Vergnon JM, Geyssant A, Lacour JR, Barthelemy JC. Reduced cardiac sympathetic autonomic tone after long-term nasal continuous positive airway pressure in obstructive sleep apnoea syndrome. Clin Physiol. 1999;19:127–134. doi: 10.1046/j.1365-2281.1999.00163.x. - DOI - PubMed

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