Obstructive sleep apnea therapy for cardiovascular risk reduction—Time for a rethink?

Abstract

Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed medical condition, which is associated with various cardiovascular and metabolic diseases. The current mainstay of therapy is continuous positive airway pressure (CPAP); however, CPAP is known to be poorly accepted and tolerated by patients. In randomized controlled trials evaluating CPAP in cardiovascular outcomes, the average usage was less than 3.5 hours, which is below the 4 hours per night recommended to achieve a clinical benefit. This low adherence may have resulted in poor effectiveness and failure to show cardiovascular risk reduction. The mandibular advancement device (MAD) is an intraoral device designed to advance the mandible during sleep. It functions primarily through alteration of the jaw and/or tongue position, which results in improved upper airway patency and reduced upper airway collapsibility. The MAD is an approved alternative therapy that has been consistently shown to be the preferred option by patients who are affected by OSA. Although the MAD is less efficacious than CPAP in abolishing apnea and hypopnea events in some patients, its greater usage results in comparable improvements in quality-of-life and cardiovascular measures, including blood pressure reduction. This review summarizes the impact of OSA on cardiovascular health, the limitations of CPAP, and the potential of OSA treatment using MADs in cardiovascular risk reduction.

Venlafaxine deprescribing and thyroid function

“…20 Patients treated by CPAP and MAD experience reduced blood pressure and weight reduction. 18 At 6 months of treatment, CPAP and MAD improve depression and quality of life scores comparably. 21 Mitigation of sleep apnea symptoms is consistent with improvement in the apnea-hypopnea index.…”

“…11 (CPAP) but more comfortable and convenient for the patient, thereby offering an option to which patients may more readily adhere. 18,19 Data from 34 randomized controlled trials found a greater than 50% reduction in the apnea-hypopnea index with MAD in adults with obstructive sleep apnea. 20 Patients treated by CPAP and MAD experience reduced blood pressure and weight reduction.…”

“…Treatment of sleep apnea with MAD has been shown to be comparatively effective to continuous positive airway pressure (CPAP) but more comfortable and convenient for the patient, thereby offering an option to which patients may more readily adhere 18,19 . Data from 34 randomized controlled trials found a greater than 50% reduction in the apnea‐hypopnea index with MAD in adults with obstructive sleep apnea 20 .…”

“…Data from 34 randomized controlled trials found a greater than 50% reduction in the apnea‐hypopnea index with MAD in adults with obstructive sleep apnea 20 . Patients treated by CPAP and MAD experience reduced blood pressure and weight reduction 18 . At 6 months of treatment, CPAP and MAD improve depression and quality of life scores comparably 21 .…”

The effect of obstructive sleep apnea therapy on cardiovascular autonomic function: a systematic review and meta-analysis

“…A large number of studies show a clear association between OSA and CVD prevalence and epidemiological studies show that OSA is associated with increased incidences of CVD [ 2 ]. However, three randomized controlled trials (RCT) tested the effect of CPAP on cardiovascular risk reduction for OSA patients, and all showed no improvement in cardiovascular end points [ 30 ]. We believe a vitally important step is to study intermediatory mechanisms of cardiovascular risk to establish mechanistic plausibility of the treatment.…”