Skip to main content

Advertisement

SpringerLink
Log in

The effect of oral appliance therapy on blood pressure in patients with obstructive sleep apnea

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

The objective of the study was to investigate the effects of oral appliance (OA) therapy on ambulatory blood pressure in patients with obstructive sleep apnea (OSA). Eleven OSA patients who received OA therapy were prospectively investigated. Ambulatory blood pressure was measured for 20 h from 4:00 p.m. to 12:00 noon the next day using an ambulatory blood pressure monitor. The Respiratory Disturbance Index (RDI) was measured in the pretreatment and posttitration periods. The OA was titrated to reach a therapeutic jaw position over 2 to 8 months, and posttitration measurements were repeated. At posttitration, the RDI was significantly decreased from a mean (SD) of 24.7 (20.1) to 6.1 (4.5). Significant reductions in diastolic blood pressure (DBP) and mean arterial pressure (MAP) were found for the 20-h periods, and systolic blood pressure (SBP), DBP, and MAP while asleep. The mean values were 79.5 (5.5) to 74.6 (6.0) for DBP and 95.9 (5.4) to 91.2 (5.9) for MAP, for over a 20-h period, and 118.4 (10.0) to 113.7 (9.1) for SBP, 71.6 (8.0) to 67.2 (7.9) for DBP, and 88.4 (8.0) to 83.9 (7.5) for MAP, while asleep. This study suggests that successful OSA treatment with an OA may also be beneficial to lower blood pressure in OSA patients, as previously suggested for nasal continuous positive airway pressure therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr A (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  2. Nieto FJ, Young TB, Lind BK, Shahar E, Samet JM, Redline S, D’Agostino RB, Newman AB, Lebowitz MD, Pickering TG (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA 283:1829–1836

    Article  PubMed  CAS  Google Scholar 

  3. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342(19):1378–1384

    Article  PubMed  CAS  Google Scholar 

  4. Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865

    Article  PubMed  CAS  Google Scholar 

  5. Randerath WJ, Heise M, Hinz R, Ruehle KH (2002) An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest 122:569–575

    Article  PubMed  Google Scholar 

  6. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA (1996) A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest 109:1269–1275

    Article  PubMed  CAS  Google Scholar 

  7. Ferguson KA, Ono T, Lowe AA, Al-Majed S, Love LL, Fleetham JA (1997) A short term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax 52:362–368

    Article  PubMed  CAS  Google Scholar 

  8. Lowe AA, Sjoholm TT, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE (2000) Treatment, airway and compliance effects of a titratable oral appliance. Sleep 23:S172–S178

    PubMed  Google Scholar 

  9. Randerath WJ, Heise M, Hinz R, Ruehle KH (2002) An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest 122:569–575

    Article  PubMed  Google Scholar 

  10. Lowe AA (2000) Oral appliances for sleep breathing disorders. In: Kryger M, Roth T, Dement W (eds) Principles and practice of sleep medicine, 3rd edn. Saunders, Philadelphia, PA, pp 929–939

    Google Scholar 

  11. Gotsopoulos H, Kelly JJ, Cistulli PA (2004) Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep 27:934–941

    PubMed  Google Scholar 

  12. Jennum P, Wildshiodtz G, Christensen NJ, Schwartz T (1989) Blood pressure, catecholamines, and pancreatic polypeptide in obstructive sleep apnea with and without nasal continuous positive airway pressure (nCPAP) treatment. Am J Hypertens 2:847–852

    PubMed  CAS  Google Scholar 

  13. Wilcox I, Grunstein RR, Collins FL, Doyle JM, Kelly DT, Sullivan CE (1992) Circadian rhythm of blood pressure in patients with obstructive sleep apnea. Blood Pressure 1:219–222

    Article  PubMed  CAS  Google Scholar 

  14. Suzuki M, Otsuka K, Guilleminault C (1993) Long-term nasal continuous positive airway pressure administration can normalize hypertension in obstructive sleep apnea patients. Sleep 16:545–549

    PubMed  CAS  Google Scholar 

  15. Engleman HM, Gough K, Martin SE, Kingshott RN, Padfield PL, Douglas NJ (1996) Ambulatory blood pressure on and off continuous positive airway pressure therapy for the sleep apnea/hypopnea syndrome: effects in “non-dippers”. Sleep 19:378–381

    PubMed  CAS  Google Scholar 

  16. Dimsdale JE, Loredo JS, Profant J (2000) Effect of continuous positive airway pressure on blood pressure. Hypertension 35:144–147

    PubMed  CAS  Google Scholar 

  17. Faccenda JF, Mackay TW, Boon NA, Douglas NJ (2001) Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 163:344–348

    PubMed  CAS  Google Scholar 

  18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National Heart, Lung, and Blood Institute. National High Blood Pressure Education Program Coordinating Committee (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42:1206–1252

    Article  PubMed  CAS  Google Scholar 

  19. Amoore JN, Dewar D, Gough K, Padfield PL (2005) Do SpaceLabs ambulatory non-invasive blood pressure recorders measure blood pressure consistently over several years use? Blood Press Monit 10(1):51–56

    Article  PubMed  Google Scholar 

  20. Becker HF, Jerrentrup A, Ploch T, Grote L, Penzel T, Sullivan CE, Peter JH (2003) Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 107:68–73

    Article  PubMed  Google Scholar 

  21. Hla KM, Skatrud JB, Finn L, Finn L, Palta M, Young T (2002) The effect of correction of sleep disordered breathing on BP in untreated hypertension. Chest 122:1125–1132

    Article  PubMed  Google Scholar 

  22. Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJO (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized parallel trial. Lancet 359:204–210

    Article  PubMed  Google Scholar 

  23. Vazquez JC, Tsai WH, Flemons WW, Masuda A, Brant R, Hajduk E, Whitelaw WA, Remmers JE (2000) Automated analysis of digital oximetry in the diagnosis of obstructive sleep apnoea. Thorax 55:302–307

    Article  PubMed  CAS  Google Scholar 

  24. Linden W, Lenz JW, Con AH (2001) Individualized stress management for primary hypertension: randomized trial. Arch Intern Med 161:1072–1080

    Article  Google Scholar 

Download references

Acknowledgements

The authors are indebted to Mrs. Ingrid Ellis for her editorial assistance and to Mrs. Mary Wong for her statistical analysis assistance. The authors would like to thank Ms. Y. Erskine and Ms. J. Leclerc, Research Co-ordinators, Behavioural Cardiology, Department of Psychology at The University of British Columbia for their assistance and advice on the ambulatory blood pressure monitoring device used. Klearway was invented by Dr. Alan A. Lowe at The University of British Columbia. International patents have been obtained by The University of British Columbia, and specific licensees are assigned the rights to manufacture and distribute the appliance worldwide. Royalties from the sale of Klearway are paid to The University of British Columbia.

Author information

Authors and Affiliations

  1. Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada

    Ryo Otsuka, Fernanda Ribeiro de Almeida & Alan A. Lowe

  2. Maxillofacial Orthognathics, Maxillofacial/Neck Reconstruction, Graduate School of Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8549, Japan

    Ryo Otsuka

  3. Department of Psychology, The University of British Columbia, Vancouver, Canada

    Wolfgang Linden

  4. Department of Medicine, Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, Canada

    Frank Ryan

Authors
  1. Ryo Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernanda Ribeiro de Almeida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alan A. Lowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Linden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Frank Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryo Otsuka.

Additional information

This study was conducted in the Division of Orthodontics, The University of British Columbia, Canada

Rights and permissions

Reprints and permissions

About this article

Cite this article

Otsuka, R., Ribeiro de Almeida, F., Lowe, A.A. et al. The effect of oral appliance therapy on blood pressure in patients with obstructive sleep apnea. Sleep Breath 10, 29–36 (2006). https://doi.org/10.1007/s11325-005-0038-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-005-0038-6

Keywords

Search

Navigation