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  • Mandibular Advancement...

Mandibular Advancement Device Matches CPAP for BP Reduction in OSA Patients: Study

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-04-23T09:00:35+05:30  |  Updated On 23 April 2024 11:56 AM IST
Mandibular Advancement Device Matches CPAP for BP Reduction in OSA Patients: Study
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Researchers have found in a new study that the mandibular advancement device (MAD) is non-inferior to continuous positive airway pressure (CPAP) therapy for reducing 24-hour mean arterial blood pressure in patients with hypertension and increased cardiovascular risk. This finding is based on a randomized, non-inferiority trial comparing the two treatments for patients with moderate-to-severe obstructive sleep apnea (OSA). This study was published in the Journal Of The American College Of Cardiology. The study was conducted by Yi-Hui and colleagues.

Hypertension guidelines recommend diagnosing and treating obstructive sleep apnea in patients with hypertension. MAD is an oral appliance therapy option for patients who decline or cannot tolerate CPAP. The effectiveness of MAD versus CPAP in reducing 24-hour ambulatory blood pressure (BP) was the focus of the study.

In an investigator-initiated, randomized, non-inferiority trial, researchers enrolled 321 participants aged over 40 with hypertension and increased cardiovascular risk from three public hospitals. A total of 220 participants with moderate-to-severe OSA (apnea–hypopnea index ≥15 events/hour) were randomized to either MAD or CPAP (1:1 ratio). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and six months.

The key findings of the studu were:

• In the MAD group, the 24-hour mean arterial BP decreased by 2.5 mmHg (P = 0.003) at six months compared to baseline.

• In the CPAP group, no significant change was observed (P = 0.374).

• The between-group difference in 24-hour mean arterial BP was -1.6 mmHg (95% confidence interval: -3.51 to 0.24), indicating non-inferiority (P < 0.001).

• The MAD group showed a larger reduction in all secondary ambulatory BP parameters compared to the CPAP group, with the most pronounced effects observed in asleep BP parameters.

• Both treatments improved daytime sleepiness, with similar between-group differences (P = 0.384).

• There were no significant between-group differences in cardiovascular biomarkers.

The study concludes that MAD is non-inferior to CPAP for reducing 24-hour mean arterial BP in patients with hypertension and increased cardiovascular risk. Given its effectiveness, MAD may provide an alternative treatment option for patients who cannot tolerate CPAP.

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

Journal Of The American College Of CardiologyMandibular advancement device (MAD)Continuous positive airway pressure (CPAP)HypertensionObstructive sleep apnea (OSA)Cardiovascular risk
Source : Journal Of The American College Of Cardiology
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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