Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial

Helene Rietz, Karl A Franklin, Bo Carlberg, Carin Sahlin, Marie Marklund, Helene Rietz, Karl A Franklin, Bo Carlberg, Carin Sahlin, Marie Marklund

Abstract

Background: Obstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea-hypopnea index, <30).

Methods and results: In this 4-month, double-blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24-hour blood pressure measurements were performed at baseline and at follow-up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0-17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea-hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7-10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.

Conclusions: A mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

Keywords: hypertension; mandibular advancement device; obstructive sleep apnea; women.

© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Figures

Figure 1
Figure 1
Flow chart showing the patients screened, randomized, and analyzed. Exclusions were made because of severe obstructive sleep apnea (OSA; n=27), body mass index ≥35 kg/m2 (n=20), <20 or ≥70 years of age (n=22), not sleepy (n=69), medical reasons (n=15), dental reasons (n=37), other ongoing OSA treatment or no treatment needed (n=109), professional driver (n=28), refused participation (n=71), and long distance to the clinic, old sleep recording, biased to the study, or included in other studies (n=43). BP indicates blood pressure; MAD, mandibular advancement device.
Figure 2
Figure 2
Systolic blood pressure (SBP) at baseline and at follow‐up after 4 months of using a mandibular advancement device (MAD) or a sham device. Values are expressed as the mean and 95% confidence interval.
Figure 3
Figure 3
Diastolic blood pressure (DBP) at baseline and at follow‐up after 4 months of using a mandibular advancement device (MAD) or a sham device. Values are expressed as the mean and 95% confidence interval.
Figure 4
Figure 4
Adjusted differences in blood pressure at follow‐up using a mandibular advancement device vs a sham device. Adjusted for baseline blood pressure, age, body mass index, and apnea‐hypopnea index. Values are expressed as the mean and 95% confidence interval. DBP indicates diastolic blood pressure; SBP, systolic blood pressure.
Figure 5
Figure 5
Scatterplots of nighttime systolic (above) and diastolic (below) blood pressure, with the baseline on the x axis and follow‐up on the y axis, with the 2 interventions in women. MAD indicates mandibular advancement device.
Figure 6
Figure 6
Scatterplots of nighttime systolic (above) and diastolic (below) blood pressure, with the baseline on the x axis and follow‐up on the y axis, with the 2 interventions in men. MAD indicates mandibular advancement device.

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