OBJECTIVE: To evaluate the effects of oral appliance (OA) treatment upon systemic blood pressure (BP) in mild to moderate patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS:Forty-six consecutive patients diagnosed with OSAHS on polysomnography were divided into OA treatment group (OA group, 25 patients, 15 patients with hypertension) and non-tolerated OA treatment group (N-OA group, 21 patients, 13 patients with hypertension). Polysomnography and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at baseline in two groups. Polysomnography and ABPM were repeated after a completion of 12 weeks of treatment in OA group and after a cessation of treatment for 12 weeks in N-OA group. Hypertensive patients in two groups continued taking the same kind and the same dose of antihypertensive agents during the period of study. RESULTS: There was no significant difference between the two groups in age, body mass index, Epworth sleepiness score (ESS), apnoea-hypopnoea index (AHI), arousal index (AI) and minimum arterial oxygen saturation (MSaO2) at baseline. After a 12-week treatment, OA group showed significant improvement in AHI [(7.0 +/- 3.8) vs (21.0 +/- 6.5) per hour, P < 0.01], AI [(22.9 +/- 6.3) vs (32.2 +/- 9.3) per hour, P < 0.01] and MSaO2 (86.8% +/- 3.5% vs 80.0% +/- 5.2%, P < 0.01), while nocturnal mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), 24-hour and diurnal SBP, and nocturnal mean artery pressure (MAP) were significantly reduced [(121.3 +/- 7.0) vs (125.3 +/- 9.3), (76.1 +/- 6.1) vs (78.8 +/- 6.8), (127.2 +/- 7.5) vs (129.4 +/- 8.8), (131.5 +/- 6.9) vs (133.6 +/- 8.1), and (91.2 +/- 6.4) vs (94.3 +/- 7.6) mm Hg respectively, all P < 0.01]. The reduction in nocturnal MAP was significantly correlated to improvement in AI(r = 0.37, P = 0.005) and AHI (r = 0.32, P = 0.011), to baseline nocturnal mean blood pressure (SBP: r = 0.39, P = 0.015; DBP: r = 0.30, P = 0.024). The N-OA group showed no differences in blood pressure variables between baseline and after a cessation of treatment for 12 weeks. CONCLUSION:Oral appliance treatment for mild to moderate OSAHS may lead to a reduction in systemic blood pressure.
RCT Entities:
OBJECTIVE: To evaluate the effects of oral appliance (OA) treatment upon systemic blood pressure (BP) in mild to moderate patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: Forty-six consecutive patients diagnosed with OSAHS on polysomnography were divided into OA treatment group (OA group, 25 patients, 15 patients with hypertension) and non-tolerated OA treatment group (N-OA group, 21 patients, 13 patients with hypertension). Polysomnography and 24-hour ambulatory blood pressure monitoring (ABPM) were performed at baseline in two groups. Polysomnography and ABPM were repeated after a completion of 12 weeks of treatment in OA group and after a cessation of treatment for 12 weeks in N-OA group. Hypertensivepatients in two groups continued taking the same kind and the same dose of antihypertensive agents during the period of study. RESULTS: There was no significant difference between the two groups in age, body mass index, Epworth sleepiness score (ESS), apnoea-hypopnoea index (AHI), arousal index (AI) and minimum arterial oxygen saturation (MSaO2) at baseline. After a 12-week treatment, OA group showed significant improvement in AHI [(7.0 +/- 3.8) vs (21.0 +/- 6.5) per hour, P < 0.01], AI [(22.9 +/- 6.3) vs (32.2 +/- 9.3) per hour, P < 0.01] and MSaO2 (86.8% +/- 3.5% vs 80.0% +/- 5.2%, P < 0.01), while nocturnal mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), 24-hour and diurnal SBP, and nocturnal mean artery pressure (MAP) were significantly reduced [(121.3 +/- 7.0) vs (125.3 +/- 9.3), (76.1 +/- 6.1) vs (78.8 +/- 6.8), (127.2 +/- 7.5) vs (129.4 +/- 8.8), (131.5 +/- 6.9) vs (133.6 +/- 8.1), and (91.2 +/- 6.4) vs (94.3 +/- 7.6) mm Hg respectively, all P < 0.01]. The reduction in nocturnal MAP was significantly correlated to improvement in AI(r = 0.37, P = 0.005) and AHI (r = 0.32, P = 0.011), to baseline nocturnal mean blood pressure (SBP: r = 0.39, P = 0.015; DBP: r = 0.30, P = 0.024). The N-OA group showed no differences in blood pressure variables between baseline and after a cessation of treatment for 12 weeks. CONCLUSION: Oral appliance treatment for mild to moderate OSAHS may lead to a reduction in systemic blood pressure.