Posted: March 15, 2016
A new article in JAMA states that outcome studies of CPAP and Oral Appliances are similar. Another article in Sleep and Breathing Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. This article concluded that "that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure."
Oral Appliances continually prove to be equal to CPAP in OUTCOME STUDIES. This is in spite of the fact that the majority of research money funds studies to show value of CPAP and that CPAP companies expect a return on their investment.
The conclusions of this study are enormous, Among patients with obstructive sleep apnea, both CPAP and MADs were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.
The Sleep and Breathing article also stated that "CPAP is more effective than MAD in eliminating respiratory events." While this is true other studies have shown that the frequency and length of use of oral appliances actually makes total effectiveness higher. Most CPAP users only utilize CPAP 30-40% of the time.
CONTACT US TODAY IF YOU WANT A COMFORTABLE ALTERNATIVE TO CPAP. STUDIES HAVE ALSO SHOWN THE MAJORITY OF PATIENTS PREFER ORAL APPLIANCES TO CPAP. 847-533-8313
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JAMA. 2015 Dec 1;314(21):2280-93. doi: 10.1001/jama.2015.16303.
CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.
Bratton DJ1, Gaisl T1, Wons AM1, Kohler M2.
Obstructive sleep apnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk.
To compare the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), and inactive control groups (placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP) in patients with obstructive sleep apnea.
The databases of MEDLINE, EMBASE, and the Cochrane Library were searched up to the end of August 2015 and study bibliographies were reviewed.
Randomized clinical trials comparing the effect of CPAP or MADs (vs each other or an inactive control) on BP in patients with obstructive sleep apnea were selected by consensus. Of 872 studies initially identified, 51 were selected for analysis.
DATA EXTRACTION AND SYNTHESIS:
Data were extracted by one reviewer and checked by another reviewer. A network meta-analysis using multivariate random-effects meta-regression was used to estimate pooled differences between each intervention. Meta-regression was used to assess the association between trial characteristics and the reported effects of CPAP vs inactive control.
MAIN OUTCOMES AND MEASURES:
Absolute change in SBP and DBP from baseline to follow-up.
Of the 51 studies included in the analysis (4888 patients), 44 compared CPAP with an inactive control, 3 compared MADs with an inactive control, 1 compared CPAP with an MAD, and 3 compared CPAP, MADs, and an inactive control. Compared with an inactive control, CPAP was associated with a reduction in SBP of 2.5 mm Hg (95% CI, 1.5 to 3.5 mm Hg; P < .001) and in DBP of 2.0 mm Hg (95% CI, 1.3 to 2.7 mm Hg; P < .001). A 1-hour-per-night increase in mean CPAP use was associated with an additional reduction in SBP of 1.5 mm Hg (95% CI, 0.8 to 2.3 mm Hg; P < .001) and an additional reduction in DBP of 0.9 mm Hg (95% CI, 0.3 to 1.4 mm Hg; P = .001). Compared with an inactive control, MADs were associated with a reduction in SBP of 2.1 mm Hg (95% CI, 0.8 to 3.4 mm Hg; P = .002) and in DBP of 1.9 mm Hg (95% CI, 0.5 to 3.2 mm Hg; P = .008). There was no significant difference between CPAP and MADs in their association with change in SBP (-0.5 mm Hg [95% CI, -2.0 to 1.0 mm Hg]; P = .55) or in DBP (-0.2 mm Hg [95% CI, -1.6 to 1.3 mm Hg]; P = .82).
CONCLUSIONS AND RELEVANCE:
Among patients with obstructive sleep apnea, both CPAP and MADs were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.
Sleep Breath. 2015 Oct 13. [Epub ahead of print]
Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime.
Glos M1, Penzel T2, Schoebel C2, Nitzsche GR2, Zimmermann S2, Rudolph C2, Blau A2, Baumann G3, Jost-Brinkmann PG4, Rautengarten S5, Meier JC4, Peroz I5, Fietze I2.
The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy(CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial.
Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min.
Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode.
These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.
Baroreceptor sensitivity; Blood pressure; Cardiac autonomic function; Continuous positive airway pressure; Heart rate variability; Mandibular advancement device; Obstructive sleep apnea