Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea

2021 ◽  
Vol 80 ◽  
pp. 294-300
Author(s):  
Hasthi U. Dissanayake ◽  
Kate Sutherland ◽  
Craig L. Phillips ◽  
Ronald R. Grunstein ◽  
Anastasia S. Mihailidou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Variability ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Splint Therapy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep

scholarly journals P013 A pilot study for ultrasound examination of the pterygomandibular raphe to predict efficacy of mandibular advancement splint therapy in obstructive sleep apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A25-A26
Author(s):  
C Brereton ◽  
A Ferreira ◽  
L Juge ◽  
L Bilston ◽  
E Brown
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Ultrasound Examination ◽  
Predictive Marker ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Anatomical Landmarks ◽  
Splint Therapy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
Healthy Participants

Abstract Background A lack of predictive indicators for mandibular advancement splint (MAS) efficacy limits their use in the treatment of obstructive sleep apnoea (OSA). The absence of a tendinous pterygomandibular raphe (PMR) in the lateral nasopharynx on MRI may predict MAS efficacy, however MRI is time and resource intensive. We aimed to assess the feasibility of ultrasound in determining PMR absence compared to MRI. Methods 10 healthy participants were recruited to undergo both MRI and ultrasound of the lateral airway. Surrounding anatomical landmarks were examined to establish the presence or absence of the PMR. These results will be compared to MRI to determine parameters on ultrasound which correlate to an absent PMR. Progress to date 8 of the 10 participants have undergone both MRI and ultrasound, of which half were women, mean age 53 years, mean BMI 28 and mean AHI 3. In all 8 participants so far parameters for assessment of the PMR were identified and described, including presence of anatomical landmarks, localisation and width of the PMR space, and presence of a hyperechoic structure within the space. Comparison of these parameters with MRI to determine predictors of PMR presence or absence is currently underway. Intended outcome and impact Validation of ultrasound in the assessment for presence or absence of a tendinous PMR will enable further study of this structure as a predictive marker for MAS efficacy in OSA. This could assist clinicians in identifying suitable patients for MAS therapy.

scholarly journals P002 Targeted non-CPAP combination therapy resolves obstructive sleep apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A22-A22
Author(s):  
A Aishah ◽  
B Tong ◽  
A Osman ◽  
M Donegan ◽  
G Pitcher ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Obstructive Sleep Apnoea ◽  
Respiratory Control ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
High Loop ◽  
Expiratory Positive Airway Pressure ◽  
Viable Treatment

Abstract Introduction Mandibular advancement splint (MAS) therapy is an effective alternative to CPAP for many people with obstructive sleep apnoea (OSA) but ~50% have residual OSA. This study aimed to resolve OSA in these individuals by combining MAS with other targeted therapies based on OSA endotype characterisation. Methods Eleven people with OSA (apnoea-hypopnoea index (AHI): 35±13 events/h), not fully resolved with MAS alone (AHI>10 events/h) were recruited. Initially, OSA endotypes were assessed via a detailed physiology night. Step one of combination therapy focused on anatomical interventions including MAS plus an oral expiratory positive airway pressure valve (EPAP) and a supine-avoidance device. Participants with residual OSA (AHI>10 events/h) following the anatomical combination therapy night, were then given one or more targeted non-anatomical therapies according to endotype characterisation. This included oxygen (4L/min) to reduce unstable respiratory control (high loop gain), 10mg zolpidem to increase arousal threshold, or 80/5mg atomoxetine-oxybutynin (ato-oxy) for poor pharyngeal muscle responsiveness. Results OSA was successfully treated (AHI<10 events/h) in all participants with combination therapy. MAS combined with EPAP and supine-avoidance therapy resolved OSA in ~65% of participants (MAS alone vs. combination therapy: 17±4 vs. 5±3, events/h, n=7). For the remaining participants, OSA resolved with the addition of oxygen (n=2), one with 80/5mg ato-oxy and another required both oxygen and 80/5mg ato-oxy. Discussion Targeted combination therapy may be a viable treatment alternative for people with OSA who cannot tolerate CPAP or for those who have an incomplete therapeutic response with monotherapy.

scholarly journals Blood Pressure Variability in Obstructive Sleep Apnoea: Data from 4 Randomised Controlled CPAP Withdrawal Trials

Respiration ◽  
2017 ◽  
Vol 93 (5) ◽  
pp. 311-318 ◽  
Author(s):  
Franziska Lettau ◽  
Esther I. Schwarz ◽  
John R. Stradling ◽  
Malcolm Kohler
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Variability ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
Randomised Controlled

scholarly journals Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis

2020 ◽  
Vol 55 (5) ◽  
pp. 1901945 ◽  
Author(s):  
Martino F. Pengo ◽  
Davide Soranna ◽  
Alice Giontella ◽  
Elisa Perger ◽  
Paola Mattaliano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Arterial Oxygen Saturation ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Arterial Oxygen ◽  
Obstructive Sleep ◽  
Randomised Controlled

The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of −2.09 (95% CI −2.78– −1.40) mmHg for systolic BP and −1.92 (95% CI −2.40– −1.43) mmHg for diastolic BP and −1.27 (95% CI −2.34– −0.20) mmHg for systolic BP and −1.11 (95% CI −1.82– −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP −2.93 mmHg), with uncontrolled BP at baseline (systolic BP −4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <77%) at baseline (24-h systolic BP −7.57 mmHg).Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.

Mandibular advancement splint titration in obstructive sleep apnoea

2008 ◽  
Vol 13 (2) ◽  
pp. 157-162 ◽  
Author(s):  
A. J. Campbell ◽  
G. Reynolds ◽  
H. Trengrove ◽  
A. M. Neill
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep
Sign in / Sign up

Export Citation Format

Share Document