Effect of oral appliance on endothelial function in sleep apnea

Lin, Ching-Chi; Wang, Huey‐Yuan; Chiu, Chung-Hsin; Liaw, Shwu-Fang

doi:10.1007/s00784-014-1234-1

Cited by 28 publications

(19 citation statements)

References 23 publications

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“…Patients with moderate and severe OSA had increased levels of serum NO levels and higher flow-mediated dilatation after implanting intra-oral devices advancing the mandible 78. Mandibular advancement device and CPAP have reduced AHI and Epworth Sleepiness Scale scores but CPAP was more efficacious.…”

Section: Effects Of Treatmentmentioning

confidence: 99%

An update on cardiovascular effects of obstructive sleep apnoea syndrome

Uyar

Davutoğlu

2016

Postgraduate Medical Journal

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Obstructive sleep apnoea syndrome is an important health problem which may cause or worsen systemic diseases. Chronic intermittent hypoxia during repetitive airflow cessations may cause endothelial dysfunction. Sleep apnoea is also shown to be associated with hypercoagulability which may be due to decreased nitric oxide levels and impaired vasodilatation. Endothelial dysfunction, increased systemic inflammation, sympathetic nervous system activation, increased oxidative stress and dysglycaemia may all contribute to cardiovascular processes such as hypertension, arrhythmia, stroke, heart failure and coronary artery disease in patients with obstructive sleep apnoea. Treatment approaches in patients with obstructive sleep apnoea mainly focus on maintaining upper airway patency either with positive airway pressure devices or upper airway appliances. Strategies involving positive airway pressure therapy are associated with decreased morbidity and mortality. Obstructive sleep apnoea should be suspected as an underlying mechanism in patients with cardiovascular disease and warrants appropriate treatment.

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Section: Effects Of Treatmentmentioning

confidence: 99%

An update on cardiovascular effects of obstructive sleep apnoea syndrome

Uyar

Davutoğlu

2016

Postgraduate Medical Journal

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“…After consensus meetings, the reviewers agreed on the methodological quality of all articles. Nine articles were considered of low [37][38][39][40][41][42][43][44][45] and 16 articles of sufficient [46][47][48][49][50] methodological quality, including 11 RCTs (n=719 patients) [51][52][53][54][55][56][57][58][59][60][61] (Table 1 shows the study characteristics of articles with sufficient methodological quality).…”

Section: Resultsmentioning

confidence: 99%

“…Inclusion of the studies with sufficient methodological quality 46,47,49,50 in the metaanalyses of daytime SBP and DBP had no influence on the overall effect (mean difference from baseline -1.92 mmHg (95% CI -3.47 to -0.38), p=0.01 and -2.45 mmHg (95% CI -3.93 to -0.97), p=0.001 for SBP and DBP, respectively). Sensitivity analyses showed a strong influence of the study by Gotsopoulos 51 on daytime SBP.…”

Section: Cardiovascular Outcomes Blood Pressurementioning

confidence: 99%

“…Sufficient methodological quality, non-RCT. Lin et al 49 compared 30 OSA patients with 15 healthy controls. Before treatment, endothelial function, measured by endotheliumdependent flow-mediated dilatation, was lower in OSA patients compared to healthy controls.…”

Section: Endothelial Function and Arterial Stiffnessmentioning

confidence: 99%

“…Due to this limitation one study on inflammatory and hemotatic markers 71 was not included in this systematic review. Regardless, even when taking this study into account, there are only a few studies considering the effect of OAT on circulating cardiovascular biomarkers; these studies are generally small and very heterogeneous with respect to their outcomes 49,50,54,59 . Therefore, further research is needed to elucidate the effects of OAT on circulating cardiovascular biomarkers and their clinical relevance.…”

Section: Circulating Cardiovascular Biomarkersmentioning

confidence: 99%

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Diagnostics and therapeutic options in obstructive and central sleep apnea syndrome

Vries¹

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Chapter 1 General introduction Chapter 2 Validity and predictive value of a portable two-channel sleepscreening tool in the identification of sleep apnea in patients with heart failure Response: A portable device as sleep-screening tool in the identification of obstructive sleep apnea in chronic heart failure: which value should we consider as cutoff? Chapter 3 Cardiovascular effects of oral appliance therapy in obstructive sleep apnea: A systematic review and meta-analysis Chapter 4 Clinical-and cost-effectiveness of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea Chapter 5 Long-term objective compliance of a mandibular advancement device versus continuous positive airway pressure in patients with moderate obstructive sleep apnea Chapter 6 Continuous positive airway pressure and oral appliance hybrid therapy in obstructive sleep apnea: patient comfort, compliance, and preference: A pilot study Chapter 7 Usage of positional therapy in adults with obstructive sleep apnea Chapter 8 Summary Chapter 9 General discussion and future perspectives Chapter 10 Nederlandse samenvatting Chapter 11 Dankwoord Chapter 1 General introduction 10 Screening and diagnostic tools Patients with sleep apnea present with a wide range of (co-)morbidities prior to their diagnosis. 32 These neurobehavioral and cardiovascular morbidities may support the consideration of having sleep apnea. Yet, establishing the diagnosis still frequently takes several years, leaving many subjects undiagnosed 33,34. Considering the abovementioned consequences of untreated sleep apnea and the impact on societal costs 33 , early diagnosis of sleep apnea is imperative. To date, sleep apnea remains underdiagnosed as it is difficult to recognize, despite the known risk factors. Polysomnography (PSG) is considered the gold standard for diagnosing sleep apnea and is typically performed in a sleep laboratory or ambulatory in a home setting. It entails recordings of (oro)nasal airflow, oxygen saturation, respiratory effort, sleep stages, snoring, eye-and leg movements, heart rate, and body position. Based on PSG, the severity of sleep apnea is classified by the number of apneas and/or hypopneas per hour of sleep (i.e. apneahypopnea index; AHI). Accordingly, sleep apnea can be classified as mild (AHI 5-15 events/h), moderate (AHI 15-30 events/h), or severe (AHI>30 events/h). As PSG is a time-consuming, costly, and specialized procedure, valid and simple alternatives are required. Polygraphy represents an alternative, but lacks the ability to identify sleep and sleep stages. Other diagnostic-and screening tools exist, for example: exclusively monitoring nasal flow and oxygen saturation, sometimes complemented with measurements of respiratory effort and pulse rate. Such devices have shown satisfactory results in terms of identifying patients with sleep apnea. Furthermore, several questionnaires, such as the Berlin questionnaire 34,35 , Epworth sleepiness scale 36 , STOP(-Bang) 37-39 , and several prediction ...

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