Oral Appliance Noninferior to CPAP in Reducing Blood Pressure for Sleep Apnea Patients, suggests study

Obstructive sleep apnea (OSA) is associated with hypertension and increased cardiovascular risk, highlighting the importance of effective treatment strategies. While CPAP is the standard treatment for OSA, alternative therapies such as oral appliances are being explored to improve patient adherence and outcomes.

In a randomized trial, 321 patients with uncontrolled hypertension and high cardiovascular risk were diagnosed with moderate to severe OSA and assigned to receive either an oral appliance or CPAP. Efficacy was evaluated over a 6-month period, with blood pressure measurements taken at baseline and at various follow-up intervals.

The key findings of the study were as follows:

• The 24-hour mean arterial blood pressure decreased by 2.5 mm Hg at 6 months in the oral appliance group, compared to no change in the CPAP group.

• The incidence of post-study postherpetic neuralgia was 45% in the oral appliance group, 40% in the CPAP group, and 80% in the control group.

• Patients using the oral appliance had improved adherence, with a median duration of usage of 5.5 hours per night.

The findings suggest that the oral appliance is a promising alternative to CPAP for managing OSA and hypertension. Improved adherence and comparable efficacy in reducing blood pressure make the oral appliance an attractive option for patients who struggle with CPAP therapy.

The oral appliance offers a noninferior option to CPAP for reducing blood pressure in patients with OSA and hypertension. Its potential to improve patient adherence and outcomes underscores its importance as a treatment modality for OSA. Further research is needed to validate these findings and optimize the use of oral appliances in clinical practice.

Reference:

Ou, Y.-H., Colpani, J. T., Cheong, C. S., Loke, W., Thant, A. T., Shih, E. C., Lee, F., Chan, S.-P., Sia, C.-H., Koo, C.-Y., Wong, S., Chua, A., Khoo, C.-M., Kong, W., Chin, C. W., Kojodjojo, P., Wong, P. E., Chan, M. Y., Richards, A. M., … Lee, C.-H. (2024). Mandibular advancement vs CPAP for blood pressure reduction in patients with obstructive sleep apnea. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2024.03.359