Autonomic Cardiac Modulation in Obstructive Sleep Apnea

Abstract

Background: Patients with obstructive sleep apnea (OSA) are characterized by deranged cardiovascular variability, a well-established marker of cardiovascular risk. While long-term treatment with continuous positive airway pressure leads to a significant improvement of cardiovascular variability, little is known of the possibility of achieving the same results with other therapeutic approaches. The aim of our study was to investigate the responses of autonomic indexes of neural cardiac control to another type of OSA treatment based on an oral jawpositioning appliance. Methods: In 10 otherwise healthy subjects with OSA (OSA؉) and in 10 subjects without OSA (OSA؊) we measured heart rate, BP, and indices of autonomic cardiac regulation derived from time-domain and spectral analysis of R-R interval (RRI), before and after 3 months of treatment with the oral device. High-frequency (HF) power of RRI was taken as an index of parasympathetic cardiac modulation, and the ratio between low-frequency (LF) and HF RRI powers as an indirect marker of the balance between sympathetic and parasympathetic cardiac modulation. Results: At baseline, in comparison with OSA؊ subjects, OSA؉ subjects displayed a significantly lower RRI variance (p < 0.02) and reduced HF RRI powers (p < 0.001). After 3 months of treatment with the oral device, the OSA؉ group showed a marked reduction in apnea-hypopnea index (p < 0.001), a lengthening in RRI and a significant increase in its variance (p < 0,02), an increased HF RRI power (from 134 ؎ 26 to 502 ؎ 48 ms 2 , p < 0.001), and a reduction in LF/HF RRI power ratio (from 3.11 ؎ 0.8 to 1.5 ؎ 0.5). As a result of these changes, after the 3-month treatment there were no more significant differences between the two groups in these parameters. In both OSA؉ and OSA؊ groups, body weight, heart rate, and BP did not change over time. Conclusions: Three months of treatment with a specific oral jaw-positioning appliance improves cardiac autonomic modulation in otherwise healthy patients with OSA of mild degree.

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

“…Improved cardiac autonomic modulation was found after 3 months' treatment with MADs in a small sample of otherwise healthy patients with mild OSA [47]. Further support for improved cardiac function was reported from an RCT including patients with moderate to severe OSA.…”

“…In addition, 21 further clinical trials that highlighted particular aspects of MAD treatment, such as the mechanisms of action and prediction of treatment outcome, were identified [1][2][3][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. A table is available in the online supplementary material.…”

Recommendations for the management of patients with obstructive sleep apnoea and hypertension

“…Effects of other specific OSA treatments besides CPAP Limited evidence is available on the effects on BP of OSA treatment through surgical procedures or through use of oral appliances; an issue which deserves to be addressed in future studies [129][130][131]. Very preliminary data are available on the effects of renal sympathetic denervation through catheter ablation technique in OSA patients, suggesting a reduction of elevated BP of OSA severity and on glycaemic control in patients with resistant hypertension [75].…”

Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults

“…Interestingly, these changes were observed after 12 months of treatment, despite the persistence of residual sleep respiratory events. The effects of treatment with MADs were also found in the autonomic nervous system, with improvements in heart rate variability, showing a modulation in autonomic nervous system (Level of Evidence IV) [28].…”