[HIMAWAN-1] Effect of Mandibular Advancement Device Therapy on Nocturnal Blood Pressure Surges in Patients with Obstructive Sleep Apnea -A Crossover Trial-
[Abstract]
[Objective]
Nocturnal blood pressure surges, which are triggered by repeated hypoxemia during sleep due to obstructive sleep apnea (OSA), have strongly associated with cardiovascular events1. In this study, we investigated the effect of mandibular advancement device (MAD) therapy on nocturnal blood pressure surges using a new technique, PTT (Pulse Transit Time) blood pressure measurement2, which can be monitoring of beat to beat blood pressure based on electrocardiogram and pulse wave.
[Method]
A crossover study was conducted on 22 OSA patients (63.5±7.7 years old, BMI: 24.6±2.0 kg/m2) with a history of hypertension, randomly assigned to MAD treatment group or placebo group. A sleep evaluation device (SomnoTouch RESP) was used to evaluate respiratory event index (REI) as an index of OSA severity, PTT systolic/diastolic blood pressure during wake and sleep, and the number of times systolic blood pressure rose above 12 mmHg per hour (surge index). Each parameter was compared (paired t-test) between the MAD treatment group and the placebo group.
[Results and Discussion]
REI was 22.8±12.8 vs 10.0±7.6/h (p<0.01), a significant decrease in the MAD group. With regard to PTT blood pressure, mean systolic blood pressure during wakefulness was 131.7±15.2 vs 121.4±14.0 mmHg (p<0.01), mean systolic blood pressure during sleep was 123.3±15.3 vs 112.8±13.7 mmHg (p<0.01) and maximum systolic blood pressure was 154.7±23.5 vs 142.2± 19.3mmHg (p<0.01), maximum systolic blood pressure change was 29.7±10.5 vs. 25.4±7.5mmHg (p<0.05), and surge index was 19.3±20.1 vs. 13.2±15.2/h (p<0.05), all showing significant decreases in the MAD group.
The new technique of PTT blood pressure was able to capture nocturnal blood pressure surges associated with OSA, and MAD treatment showed significant PTT blood pressure reduction with improvement in REI. The results of this study suggest that MAD treatment may be effective not only for sleep-disordered breathing associated with OSA, but also for other cardiovascular conditions such as nocturnal blood pressure surges.
[References]
1) Kario K. Nocturnal Hypertension: New Technology and Evidence. Hypertension 2018; 71.
2) Hoshide S, Yoshihisa A, Tsuchida F, et al. Pulse transit time-estimated blood pressure: a comparison of beat-to-beat and intermittent measurement. Hypertens Res 2022; 45.
[Objective]
Nocturnal blood pressure surges, which are triggered by repeated hypoxemia during sleep due to obstructive sleep apnea (OSA), have strongly associated with cardiovascular events1. In this study, we investigated the effect of mandibular advancement device (MAD) therapy on nocturnal blood pressure surges using a new technique, PTT (Pulse Transit Time) blood pressure measurement2, which can be monitoring of beat to beat blood pressure based on electrocardiogram and pulse wave.
[Method]
A crossover study was conducted on 22 OSA patients (63.5±7.7 years old, BMI: 24.6±2.0 kg/m2) with a history of hypertension, randomly assigned to MAD treatment group or placebo group. A sleep evaluation device (SomnoTouch RESP) was used to evaluate respiratory event index (REI) as an index of OSA severity, PTT systolic/diastolic blood pressure during wake and sleep, and the number of times systolic blood pressure rose above 12 mmHg per hour (surge index). Each parameter was compared (paired t-test) between the MAD treatment group and the placebo group.
[Results and Discussion]
REI was 22.8±12.8 vs 10.0±7.6/h (p<0.01), a significant decrease in the MAD group. With regard to PTT blood pressure, mean systolic blood pressure during wakefulness was 131.7±15.2 vs 121.4±14.0 mmHg (p<0.01), mean systolic blood pressure during sleep was 123.3±15.3 vs 112.8±13.7 mmHg (p<0.01) and maximum systolic blood pressure was 154.7±23.5 vs 142.2± 19.3mmHg (p<0.01), maximum systolic blood pressure change was 29.7±10.5 vs. 25.4±7.5mmHg (p<0.05), and surge index was 19.3±20.1 vs. 13.2±15.2/h (p<0.05), all showing significant decreases in the MAD group.
The new technique of PTT blood pressure was able to capture nocturnal blood pressure surges associated with OSA, and MAD treatment showed significant PTT blood pressure reduction with improvement in REI. The results of this study suggest that MAD treatment may be effective not only for sleep-disordered breathing associated with OSA, but also for other cardiovascular conditions such as nocturnal blood pressure surges.
[References]
1) Kario K. Nocturnal Hypertension: New Technology and Evidence. Hypertension 2018; 71.
2) Hoshide S, Yoshihisa A, Tsuchida F, et al. Pulse transit time-estimated blood pressure: a comparison of beat-to-beat and intermittent measurement. Hypertens Res 2022; 45.