Abstract 15463: Mandibular Advancement Device With Precise Usage Monitor Showed Comparable Cardiovascular Effects as Continuous Positive Airway Pressure Among Patients With Moderate to Severe Sleep Disordered Breathing

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A15463-A15463
• Main Authors: Yamamoto, Umpei, Soda, Sayaka, Handa, Sakiko, Tokunou, Tomotake, Nishizaka, Mari, Tsuda, Hiroko, Ando, Shin-ichi
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionMandibular advancement device (MAD) has shown better compliance but comparable or reduced improvement in sleep rerated parameters, symptoms and blood pressure than continuous positive airway pressure (CPAP) in previous studies where usage of MAD was measured by declaration of patients. Furthermore, the effectiveness of MAD for endothelial function compared with CPAP is not known.HypothesisWe assessed the hypothesis that patients with moderate to severe sleep disordered breathing (SDB) might use MAD longer than CPAP and MAD would be as effective as CPAP in terms of sleep related parameters and symptoms, endothelial function, and ambulatory blood pressure.MethodsThirty two moderate to severe obstructive SDB patients with apnea hypopnea index (AHI) between 20 and 40/h by polysomnography and without previous therapy for SDB were randomly assigned either to CPAP or MAD. Devices were crossovered after 8 weeks and treated for same period. We evaluated compliance by novel compliance monitor implanted in each MAD, excessive daytime sleepiness, nocturia, and SDB related parameters by portable polygraphy, endothelial function by measured flow mediated dilatations (FMD), ambulatory blood pressure monitoring (ABPM) at the end of each therapy.ResultsUsage time was unexpectedly comparable in CPAP and MAD(293.0±95.6min vs. 313.1±149.8min, p=0.3). Although improvement in AHI (by CPAP 23.7±7.8/h, by MAD 18.4±9.8/h, P=0.03)and other sleep related parameters from the baseline significantly more by CPAP, daytime sleepiness measured by Epworth sleepiness scale and frequency of nocturia were improve comparably by both therapies. Changes in FMD (by CPAP 0.30±5.4% , by MAD 0.29±4.8%,p=0.96) and 24h mean blood pressure (BP) measured by ABPM (by CPAP -0.3±1.4mmHg, by MAD -0.5±1.5mmHg,p=0.83) as well as changes in average diurnal and nocturnal BP in both therapies were comparable.ConclusionsIn conclusion, MAD has equivalent compliance, sleep related symptoms and cardiovascular effects as CPAP, though improvement of BP and endothelial function were insignificant by both therapies.