Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Abstract

BackgroundObstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea‐hypopnea index, <30).Methods and ResultsIn this 4‐month, double‐blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24‐hour blood pressure measurements were performed at baseline and at follow‐up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0–17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea‐hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7–10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.ConclusionsA mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

Gender Differences in Obstructive Sleep Apnea: The Value of Sleep Questionnaires with a Separate Analysis of Cardiovascular Patients

“…OSA has been associated with several cardiovascular consequences, such as hypertension, stroke, and arrhythmias, and in some studies, there is an increased incidence of these cardiovascular outcomes in women suffering from severe disease [33]. CPAP and the Mandibular Advancement Device reversed this risk (especially blood pressure) in women with adequate compliance [26,30,34]. An increased awareness of gender differences leading to improved diagnosis and treatment are essential.…”

Update on oral appliance therapy

“…Blood pressure is reduced from MAD treatment compared with placebo and mostly to a similar degree as with CPAP in the relatively small samples studied [5,9,11]. The blood pressure effects are particularly evident at night-time, in hypertensive patients and probably among females [18,[42][43][44][45][46][47]. Sex differences in effects from OSA treatments are mainly unknown, since mixed samples have included a majority of males (80% on average).…”

An Update on Obstructive Sleep Apnea for Atherosclerosis: Mechanism, Diagnosis, and Treatment

“…Interestingly, it was reported that sex might affect the treatment with MAD. For women with MAD, the nighttime systolic and diastolic blood pressure was 10.8 and 6.6 mm Hg, respectively, lower than those in the sham group, while no significant differences were observed in men ( 93 ). However, the results comprised of 27 women and 58 men and might not present an unbiased conclusion.…”