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Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial

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Abstract

Background

Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation.

Methods

Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring.

Results

Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP >135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) ≤15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls.

Conclusions

In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI ≤15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.

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Acknowledgments

The project was financially supported by grants from the County of Västmanland, Sweden, the Swedish Heart and Lung Foundation, and the Swedish Dental Association.

The authors wish to thank Yvonne Pettersson, dental assistant, for her active role in the administration and rolling of the patients.

Author information

Authors and Affiliations

  1. Department of Stomatognathic Physiology, Västmanland County Hospital, 729 81, Västerås, Sweden

    Ann Andrén & Åke Tegelberg

  2. Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden

    Pär Hedberg, Marie-Louise Walker-Engström & Åke Tegelberg

  3. Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden

    Pär Hedberg & Petra Wahlén

  4. Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Malmö, Sweden

    Åke Tegelberg

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  1. Ann Andrén
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Correspondence to Ann Andrén.

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Andrén, A., Hedberg, P., Walker-Engström, ML. et al. Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension: a randomized clinical trial. Sleep Breath 17, 705–712 (2013). https://doi.org/10.1007/s11325-012-0746-7

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  • DOI: https://doi.org/10.1007/s11325-012-0746-7

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