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Mandibular advancement devices decrease systolic pressure during the day and night in patients with obstructive sleep
Alba Belanche Monterde1, Álvaro Zubizarreta-Macho2,3, Ana Belén Lobo Galindo1
1Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain.
Sleep & Breathing = Schlaf & Atmung
|January 5, 2024
Summary
Mandibular advancement devices (MADs) do not significantly alter diastolic blood pressure in obstructive sleep apnea (OSA) patients. However, MAD use can reduce systolic blood pressure, especially when used at night and for longer durations.
Area of Science:
- Cardiovascular Health
- Sleep Medicine
- Biomedical Engineering
Background:
- Obstructive sleep apnea (OSA) is a prevalent sleep disorder associated with cardiovascular complications, including hypertension.
- Mandibular advancement devices (MADs) are a common treatment for OSA, aiming to improve airway patency.
- The impact of MADs on blood pressure, particularly systolic and diastolic levels, requires thorough investigation.
Purpose of the Study:
- To systematically review and meta-analyze the effect of MADs on blood pressure in OSA patients.
- To investigate whether the time of day (night vs. day) or duration of MAD use influences blood pressure changes.
- To determine the relationship between MAD treatment and changes in systolic and diastolic blood pressure.
Main Methods:
- A systematic literature review and meta-analysis were conducted following PRISMA guidelines.
- Four databases (PubMed-Medline, Scopus, Web of Science, Cochrane) were searched, yielding 17 articles for qualitative and 4 for quantitative analysis.
- Random effects models and meta-regression were used to analyze blood pressure changes (systolic and diastolic) in relation to MAD use, considering circadian effects and treatment duration.
Main Results:
- MAD treatment did not significantly affect diastolic blood pressure in OSA patients (mean difference -0.06 mmHg).
- Overall, MADs showed a non-significant trend towards reducing systolic blood pressure (mean difference -0.99 mmHg).
- Meta-regression revealed that MAD use at night and longer treatment durations were significantly associated with reductions in systolic blood pressure (p < 0.001).
Conclusions:
- Systolic blood pressure is the primary pressure parameter affected by MAD use in OSA patients.
- The hypotensive effect of MADs on systolic blood pressure is more pronounced with nocturnal use and extended treatment periods.
- MADs represent a potential therapeutic option for managing hypertension in OSA patients, particularly concerning systolic pressure control.
