Devices that mechanically reduce likelihood of sleep apnea improve sleep quality, but may not lower risk for heart disease

Research recently published in the American Journal of Respiratory and Critical Care Medicine suggests that patients with severe obstructive sleep apnea who use oral appliances to move their lower jaw get a somewhat better night’s sleep, but may not see their risk for cardiovascular diminish.

"Endothelial dysfunction is one of the intermediate mechanisms that potentially contribute to the increased risk of cardiovascular disease in [obstructive sleep apnea (OSA)]," Frédéric Gagnadoux, MD, professor of pulmonology at the University Hospital of Angers, France, said in a press release. "Whether [mandibular advancement device (MAD)] therapy improves endothelial function in OSA patients had not been evaluated before in properly controlled and adequately powered trials."

According to the release, although continuous positive airway pressure (CPAP), is the “gold standard” for treatment of OSA, many patients find it uncomfortable and look to MADs, which move the jaw forward, making the upper airway larger and reducing the risk for sleep apnea and snoring, as an alternative. Gagnadoux and colleagues also wrote that previous studies looking into CPAP’s effect on endothelial function have been inconclusive.

Gagnadoux and colleagues studied 150 patients (86% men) who had apnea-hypopnea index (AHI) of 30 or higher and an Epworth Sleepiness Scale (ESS) score of 16 or higher. Half of the participants received a MAD, while the others received a sham device. Both groups received 2 months of treatment.

The researchers reported that at study’s end, the median AHI was 41 and the mean ESS was 9.3 in patients using MADs. On intention-to-treat analysis, MADs were also connected to significant improvements in micro-arousal index (P = .008), and symptoms of snoring, fatigue and sleepiness (P < .001). The mean objective compliance was 6.6 hours a night compared with 5.6 hours a night with the sham device. MADs were not associated with improvement of endothelial function compared with the sham devices. The MADs also had no effect on BP.

Gagnadoux and colleagues wrote that their study could lead to research that could discover other potential benefits of MADs.

“Although our post hoc analysis showed no intergroup differences in [reactive hyperemia index (RHI)] outcome in patients with low baseline RHI, further studies are required to determine whether MAD therapy for OSA can improve endothelial function in patients with overt cardiovascular disease and metabolic disorders, who exhibit more severe endothelial dysfunction at baseline,” researchers wrote. – by Janel Miller

Disclosure: The researchers reported no relevant financial disclosures.