Effect on blood pressure of oral appliance therapy for sleep apnea syndrome.
ABSTRACT The aim of this study was to evaluate the effect of individually prescribed oral appliances for the treatment of obstructive sleep apnea syndrome (OSAS) on blood pressure, as well as factors influencing the efficacy.
One hundred sixty-one patients (121 men and 40 women, mean age: 54.3 +/- 13.7 years) diagnosed with mild to moderate OSAS (mean apnea-hypopnea index: 17.9 +/- 14.1) were studied before and after insertion of a mandibular advancement device, with a mean interval of 60 days. Systolic, diastolic, and mean blood pressure was taken using an automatic blood pressure monitor (132.0 +/- 16.1 mmHg, 82.1 +/- 10.6 mmHg, 107.1 +/- 12.9 mmHg, respectively, at baseline).
The patients were subdivided into 3 groups: responder, partial responder, and nonresponder, according to the difference of mean arterial pressure fall after the treatment. The systolic, diastolic, and mean blood pressure decreased significantly (P < .001) (127.5 +/- 15.0 mmHg, 79.2 +/- 10.0 mmHg, 103.4 +/- 12.0 mmHg, respectively) after the insertion of the device. The oral appliance therapy produced falls in blood pressure (4.5 mmHg, 3.0 mmHg, 3.7 mmHg, respectively). The response was significantly (P < .001) correlated to baseline blood pressure. The responders (n = 70, mean blood pressure fall > 3.7 mmHg) and the partial responders (n=46, 0 < fall < or = 3.7 mmHg) showed significantly (P < .05; analysis of variance) higher reduction in apnea-hypopnea index (69.6%, 65.9%, respectively) than that (52.5%) of nonresponders (n=45, fall < or =0 mmHg).
These data suggest that effective oral appliance therapy for OSAS patients with hypertension can lead to a substantial reduction in daytime blood pressure.
- SourceAvailable from: M.Safwan Badr
Article: Central sleep apnea.[Show abstract] [Hide abstract]
ABSTRACT: Central sleep apnea (CSA) is characterized by the periodic occurrence of apnea caused by loss of ventilatory motor output. CSA is often discussed as a minor variant of obstructive sleep apnea.However, this view obscures the critical contribution of CSA as an important manifestation of breathing instability in a variety of conditions with diverse causes. Central apnea can also be a physiologic phenomenon in healthy people during sleep onset. Conversely, patients who have obstructive apnea may also develop episodes of apparent central apnea, and apneas that begin as central may become obstructive as respiratory effort is restored ("mixed apneas"). Thus, there is a significant overlap between obstructive and central apnea. This article addresses the pathophysiology, clinical features, and management of normocapnic and hypercapnic CSA.Primary Care Clinics in Office Practice 07/2005; 32(2):361-74, vi. DOI:10.1016/j.pop.2005.02.003 · 0.83 Impact Factor
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ABSTRACT: Oral appliances (OAs) are a primary treatment option for snoring and mild to moderate obstructive sleep apnea (OSA) and are implemented as a noninvasive alternative for patients with severe OSA who are unwilling or unable to tolerate continuous positive airway pressure for the management of their disease. Studies have demonstrated the ability of OAs to eliminate or significantly reduce the symptoms of OSA and produce a measurable influence on the long-term health effects of the disease. Most studies have evaluated one type of OAs, the mandibular advancement splints. This article describes the effectiveness and outcomes of mandibular advancement splints.Dental clinics of North America 04/2012; 56(2):433-44. DOI:10.1016/j.cden.2012.02.003
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ABSTRACT: Mandibular advancement appliances (MAA) are a recognized alternative treatment to continuous positive airway pressure (CPAP) for mild-moderate obstructive sleep apnea syndrome (OSAS). The aim of this study is to assess the efficacy of and subject satisfaction with two MAA in the management of OSAS. Five women and 11 men (47.9+/-1.6 years), previously untreated with CPAP, were recruited from a sleep disorders clinic following a polysomnographic diagnosis of mild-moderate OSAS with Respiratory Disturbance Index (RDI) of 9.4+/-1.1. A randomized single blind cross-over study was completed with both Klearway and Silencer (three months for each study arm). Subjects completed standardized questionnaires on sleep quality, sleepiness and functional outcomes (Functional Outcome Sleep Questionnaire: FOSQ). MAA satisfaction (e.g., comfort) and efficacy (e.g., reduction of respiratory noises, headache) were assessed by subjects and sleep partner. The two MAA (Silencer 4.7+/-0.9 and Klearway 6.5+/-1.3) significantly reduced the RDI compared to the baseline night (10.0+/-1.2, respectively p<0.001 and p<0.01). The RDI was slightly lower with the Silencer (p0.05) but subjects' preference for comfort was in favor of the Klearway (Klearway 7.0+/-0.4 vs Silencer 5.8+/-0.4, p=0.04). The Epworth score, FOSQ, respiratory noise and morning headache were also improved following use of both appliances (p0.05 to 0.001). Although both MAA decreased RDI and subjective daytime sleepiness in a similar manner, the choice between various types of MAA needs to be taken into account when considering the benefit of RDI reduction over the benefit of subject compliance. The long term benefit of increased RDI reduction vs. a better subject compliance needs to be assessed in prospective studies.Sleep Medicine 06/2008; 10(3):329-36. DOI:10.1016/j.sleep.2008.03.011 · 3.10 Impact Factor