Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea

• DOI: 10.1016/j.jacc.2024.03.359
• Publication Date: 2024-04-06T22:17:34Z
• Authors: Yi-Hui Ou; Juliana Tereza Co...; Crystal S. Cheong; Weiqiang Loke; As tar Thant; E’ Ching Shih; Frank Lee; Siew-Pang Chan; Ching-Hui Sia; Chieh-Yang Koo; Serene Wong; Aiping Chua; Chin-Meng Khoo; William Kong; Calvin W. Chin; Pipin Kojodjojo; Philip E. Wong; Mark Y. Chan; A. Mark Richards; Peter A. Cistulli; Chi-Hang Lee
• Keywords: Oral appliance

Hypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for who decline or cannot tolerate CPAP. We compared the relative effectiveness MAD versus CPAP reducing 24-hour ambulatory BP. In investigator-initiated, randomized, non-inferiority trial (pre-specified margin 1.5 mmHg), 321 participants, aged over 40, hypertension increased cardiovascular risk were recruited at 3 public hospitals polysomnography. Of these, 220 participants moderate-to-severe OSA (apnea–hypopnea index (AHI) ≥15 events/hour) randomized to either (1:1). primary outcome was difference between mean arterial BP baseline 6 months. Compared baseline, decreased by 2.5 mmHg (P = 0.003) months group, whereas no change observed group 0.374). between-group -1.6 (95% confidence interval: -3.51 0.24, P < 0.001). demonstrated a larger reduction all secondary parameters most pronounced effects asleep parameters. Both improved daytime sleepiness, similar 0.384). There differences biomarkers. non-inferior risk.