Among patients with obstructive sleep apnea, a comparison of the treatments continuous positive airway pressure and mandibular advancement devices found both were associated with similar reductions in systolic and diastolic blood pressure, according to a study in the December 1 issue of JAMA.
Obstructive sleep apnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk. Malcolm Kohler, M.D., of University Hospital Zurich, Zurich, Switzerland, and colleagues conducted a meta-analysis and compared the association of continuous positive airway pressure (CPAP) vs mandibular advancement devices (MADs) and vs an inactive control (e.g., placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP) in patients with obstructive sleep apnea. Mandibular advancement devices work by protruding the mandible and tongue to keep airways open during sleep.
A total of 51 studies (4,888 patients) met criteria for the meta-analysis. Of these studies, 44 compared CPAP with an inactive control (4,289 patients), compared MADs with an inactive control (229 patients), 1 compared CPAP with MADs (126 patients), and 3 compared CPAP, MADs, and an inactive control (244 patients). Results of the meta-analysis found that compared with an inactive control, CPAP was associated with a reduction in SBP of 2.5 mm Hg and in DBP of 2.0 mm Hg; MADs were associated with a reduction in SBP of 2.1 mm Hg and in DBP of 1.9 mm Hg.
The authors note that even though there was no statistically significant difference between the associations of CPAP and MADs with change in BP in the meta-analysis, CPAP had a considerably higher probability of having the strongest association with SBP reduction. "The associations of both CPAP and MADs with DBP reduction were more similar; however, the association of CPAP with reductions of both SBP and DBP is likely to be greater in patients using CPAP for longer periods at night or in those with higher baseline BP levels."