Sleep apnea: Mouthguards less invasive, just as effective as CPAP

🌈 Abstract

The article compares the effectiveness of mouthguards (mandibular advancement devices or MADs) and continuous positive airway pressure (CPAP) machines in treating obstructive sleep apnea and reducing high blood pressure.

🙋 Q&A

[01] Comparison of MADs and CPAP

1. What were the key findings of the study comparing MADs and CPAP?

• The study found that MADs were non-inferior to CPAP in reducing 24-hour mean blood pressure in patients with moderate-to-severe obstructive sleep apnea.
• MADs showed a larger reduction in all ambulatory blood pressure measures, especially nighttime blood pressure, compared to the CPAP group.
• More participants in the MAD group achieved a systolic blood pressure below 120 mmHg.
• Adherence was higher in the MAD group, with over 56% using it for 6 or more hours per night on average, compared to 23.2% in the CPAP group.

2. What are the pros and cons of MADs and CPAP devices?

• CPAP is effective but tends to be uncomfortable and poorly tolerated by patients.
• MADs are less intrusive but have been shown to be outperformed by CPAP in terms of the apnea-hypopnea index (AHI).
• However, the study found that MADs were just as effective as CPAP in reducing blood pressure, and had better adherence rates.

3. What are the implications of these findings for the treatment of obstructive sleep apnea?

• The researchers suggest that for patients who cannot tolerate or accept CPAP, MADs should be considered as an alternative therapy, as they can provide similar blood pressure reduction benefits.
• The study highlights the importance of treating obstructive sleep apnea, which is an underdiagnosed and modifiable risk factor for high blood pressure.

[02] Study Design and Limitations

1. How was the study designed?

• It was a randomized controlled trial that recruited 220 participants with moderate-to-severe obstructive sleep apnea and assigned them to either CPAP or MAD treatment.
• The primary outcome was the difference in 24-hour mean blood pressure between baseline and 6-month follow-up.

2. What were the limitations of the study?

• The study participants were predominantly of East Asian descent and male, so further research is needed to determine if the results are generalizable to more diverse populations.
• Adherence may have been higher due to the study being conducted during COVID-19 travel lockdowns.

3. What future research is planned?

• The researchers plan to examine the impacts of the CPAP and MAD devices on cognition in further studies.