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The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Background

Moderate and severe obstructive sleep apnea (OSA) have been independently associated with dyslipidemia. The results of metabolic improvement with continuous positive airway pressure (CPAP) have been controversial. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is mandibular advancement device (MAD) therapy, but its effectiveness on the metabolic profile needs to be compared with CPAP. The purpose of this study was to compare MAD vs CPAP vs no treatment on the metabolic profile during 6 and 12 months of follow-up in patients with mild OSA.

Methods

The inclusion criteria were patients with mild OSA, both genders, ages 18 to 65 years, and body mass index (BMI) of < 35 Kg/m2. Patients were randomized in 3 groups (CPAP, MAD, and control). The evaluations included physical examination, metabolic profile, and full polysomnography at baseline, 6 months, and 12 months of follow-up.

Results

Seventy-nine patients with mild OSA were randomized in three treatment groups, with mean age (± SD) of 47 ± 9 years, 54% men, and AHI 9.5 ± 2.9 events/h. MAD and CPAP reduced AHI at 6 and 12 months compared to the control group. MAD adherence was higher than CPAP at 6 and 12 months. Despite lower adherence compared to MAD, CPAP was more effective in reducing total cholesterol over 12 months (baseline 189.3 ± 60.2 mg/dl to 173.4 ± 74.3 mg/dl) and low-density lipoprotein cholesterol (LDL-c, baseline 112.8 ± 54.9 mg/dl to 94.5 ± 67.4 mg/dl).

Conclusions

After 1 year of treatment, CPAP was superior to MAD in reducing total cholesterol and LDL-c in patients with mild OSA.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. Ruan H, Lodish HF (2003) Insulin resistance in adipose tissue: direct and indirect effects of tumor necrosis factor-alpha. Cytokine Growth Factor Rev 14:447–455

    Article  CAS  PubMed  Google Scholar 

  3. Luyster FS (2017) Impact of obstructive sleep apnea and its treatments on partners: a literature review. J Clin Sleep Med 13:467–477

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LR (2010) Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med 11:441–446

    Article  PubMed  Google Scholar 

  5. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014

    Article  PubMed  PubMed Central  Google Scholar 

  6. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    Article  PubMed  Google Scholar 

  7. Battan G, Kumar S, Panwar A et al (2016) Effect of CPAP therapy in improving daytime sleepiness in Indian patients with moderate and severe OSA. J Clin Diagn Res 10:OC14–OC16

    PubMed  PubMed Central  Google Scholar 

  8. Ackel-D'Elia C, da Silva AC, Silva RS et al (2012) Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 16:723–735

    Article  PubMed  Google Scholar 

  9. Cunali PA, Almeida FR, Santos CD, Valdrichi NY, Nascimento LS, Dal-Fabbro C, Tufik S, Bittencourt LRA (2011) Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 15:717–727

    Article  PubMed  Google Scholar 

  10. Diaferia G, Badke L, Santos-Silva R, Bommarito S, Tufik S, Bittencourt L (2013) Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Med 14:628–635

    Article  PubMed  Google Scholar 

  11. Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev:CD004435

  12. Balachandran JS, Bakker JP, Rahangdale S, Yim-Yeh S, Mietus JE, Goldberger AL, Malhotra A (2012) Effect of mild, asymptomatic obstructive sleep apnea on daytime heart rate variability and impedance cardiography measurements. Am J Cardiol 109:140–145

    Article  PubMed  Google Scholar 

  13. Zhang D, Luo J, Qiao Y, Xiao Y (2016) Continuous positive airway pressure therapy in non-sleepy patients with obstructive sleep apnea: results of a analysis. J Thorac Dis 8:2738–2747

    Article  PubMed  PubMed Central  Google Scholar 

  14. AASM. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research (1999). In: Sleep pp. 667–689

  15. AASM (2005) International Classification of Sleep Disorders. In: Medicine AAoS (ed) Diagnostic and coding manual (ICSD-2), 2nd edn edn, Westchester, IL

  16. Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA, Positive Airway Pressure Titration Task Force, American Academy of Sleep Medicine (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4:157–171

    Article  PubMed  Google Scholar 

  17. Dal-Fabbro C, Chaves-Jr CM, Bittencourt LRA, Tufik S (2010) Clinical and polysomnographic assessment of the BRD appliance in the treatment of obstructive sleep apnea syndrome. Dental Press J Ortho 15:107–117

    Article  Google Scholar 

  18. Corbin CB, Lindsey R (1994) Concepts of physical fitness with laboratories. WCB Brown & Benchmark, Indianapolis

    Google Scholar 

  19. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW (2009) Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 35:877–883

    Article  PubMed  Google Scholar 

  20. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  21. Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, Woods N (2001) Executive summary: stages of reproductive aging workshop (STRAW). Fertil Steril 76:874–878

    Article  CAS  PubMed  Google Scholar 

  22. Kupperman HS, Wetchler BB, Blatt MHG (1959) Contemporary therapy of the menopausal syndrome. J Am Med Assoc 171:1627–1637

    Article  CAS  PubMed  Google Scholar 

  23. Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ et al (2013) V Brazilian guidelines on dyslipidemias and prevention of atherosclerosis. Arq Bras Cardiol 101(4 Suppl 1):1–20

    Article  CAS  PubMed  Google Scholar 

  24. Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules terminology and technical specifications. American Academy of Sleep Medicine Westchester, IL

  25. Xu H, Yi H, Guan J, Yin S (2014) Effect of continuous positive airway pressure on lipid profile in patients with obstructive sleep apnea syndrome: a meta-analysis of randomized controlled trials. Atherosclerosis 234(2):446–453

    Article  CAS  PubMed  Google Scholar 

  26. Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJ, de Bont LG, Stegenga B (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 1;36(9):1289–1296

    Article  Google Scholar 

  27. Keenan BT, Maislin G, Sunwoo BY, Arnardottir ES, Jackson N, Olafsson I, Juliusson S, Schwab RJ, Gislason T, Benediktsdottir B, Pack AI (2014) Obstructive sleep apnoea treatment and fasting lipids: a comparative effectiveness study. Eur Respir J 44:405–414

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Jullian-Desayes I, Joyeux-Faure M, Tamisier R, Launois S, Borel AL, Levy P, Pepin JL (2015) Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials. Sleep Med Rev 21:23–38

    Article  PubMed  Google Scholar 

  29. Martínez-García MA, Campos-Rodríguez F, Catalán-Serra P, Soler-Cataluña JJ, Almeida-Gonzalez C, de la Cruz Morón I, Durán-Cantolla J, Montserrat JM (2012) Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous positive airway pressure treatment: a prospective observational study. Am J Respir Crit Care Med 186:909–916

    Article  PubMed  Google Scholar 

  30. Morris MJ, Beilharz JE, Maniam J, Reichelt AC, Westbrook RF (2014) Why is obesity such a problem in the 21st century? The intersection of palatable food, cues and reward pathways, stress, and cognition. Neurosci Biobehav Rev 58:36–45

    Article  PubMed  Google Scholar 

  31. Schlatzer C, Schwarz EI, Kohler M (2014) The effect of continuous positive airway pressure on metabolic variables in patients with obstructive sleep apnoea. Chron Respir Dis 11:41–52

    Article  PubMed  Google Scholar 

  32. Prabhakar NR (2002) Sleep apneas: an oxidative stress? Am J Respir Crit Care Med 165:859–860

    Article  PubMed  Google Scholar 

  33. Feres MC, Fonseca FA, Cintra FD et al (2015) An assessment of oxidized LDL in the lipid profiles of patients with obstructive sleep apnea and its association with both hypertension and dyslipidemia, and the impact of treatment with CPAP. Atherosclerosis 241:342–349

    Article  CAS  PubMed  Google Scholar 

  34. Buechner NJ, Zidek W, Esser M, Haske M, Sanner BM (2001) Obstructive sleep apnea syndrome. Effects of therapy on dyslipidemia. Somnologie 5:97–102

    Article  Google Scholar 

  35. Chin K, Shimizu K, Nakamura T, Narai N, Masuzaki H, Ogawa Y, Mishima M, Nakamura T, Nakao K, Ohi M (1999) Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. Circulation 100:706–712

    Article  CAS  PubMed  Google Scholar 

  36. Salord N, Fortuna AM, Monasterio C, Gasa M, Pérez A, Bonsignore MR, Vilarrasa N, Montserrat JM, Mayos M (2016) A randomized controlled trial of continuous positive airway pressure on glucose tolerance in obese patients with obstructive sleep apnea. Sleep 39:35–41

    Article  PubMed  PubMed Central  Google Scholar 

  37. Malik JA, Masoodi SR, Shoib S (2017) Obstructive sleep apnea in type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control. Indian J Endocrinol Metab 21:106–112

    Article  PubMed  PubMed Central  Google Scholar 

  38. Iftikhar IH, Khan MF, Das A, Magalang UJ (2013) Analysis: continuous positive airway pressure improves insulin resistance in patients with sleep apnea without diabetes. Ann Am Thorac Soc 10:115–120

    Article  PubMed  PubMed Central  Google Scholar 

  39. Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA (2011) Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 96:365–374

    Article  CAS  PubMed  Google Scholar 

  40. Ioachimescu OC, Anthony J, Constantin T, Ciavatta MM, McCarver K, Sweeney ME (2017) VAMONOS (veterans affairs' metabolism, obstructed and non-obstructed sleep) study: effects of CPAP therapy on glucose metabolism in patients with obstructive sleep apnea. J Clin Sleep Med 13:455–466

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kaur A, Mokhlesi B (2017) The effect of OSA therapy on glucose metabolism: It's all about CPAP adherence! J Clin Sleep Med 13:365–367

    Article  PubMed  PubMed Central  Google Scholar 

  42. Galic T, Bozic J, Ivkovic N, Gunjaca G, Kurir Ticinovic T, Dogas Z (2015) Effects of mandibular advancement device treatment on arterial stiffness and glucose metabolism in patients with mild to moderate obstructive sleep apnea: a prospective 1 year study. Sleep Breath 20(1):69–77

    Article  PubMed  Google Scholar 

  43. Niżankowska-Jędrzejczyk A, Almeida FR, Lowe AA, Kania A, Nastałek P, Mejza F, Foley JH, Niżankowska-Mogilnicka E, Undas A (2014) Modulation of inflammatory and hemostatic markers in obstructive sleep apnea patients treated with mandibular advancement splints: a parallel, controlled trial. J Clin Sleep Med 10:255–262

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dal-Fabbro C, Garbuio S, D'Almeida V, Cintra FD, Tufik S, Bittencourt L (2014) Mandibular advancement device and CPAP upon cardiovascular parameters in OSA. Sleep Breath 18:749–759

    Article  PubMed  Google Scholar 

  45. Trzepizur W, Gagnadoux F, Abraham P, Rousseau P, Meslier N, Saumet JL, Racineux JL (2009) Microvascular endothelial function in obstructive sleep apnea: impact of continuous positive airway pressure and mandibular advancement. Sleep Med 10:746–752

    Article  PubMed  Google Scholar 

  46. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, Marks GB, Cistulli PA (2013) Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 187:879–887

    Article  PubMed  Google Scholar 

  47. Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N, Patel SR, Patil S, Knight SL, Rowley JA, Slyman A, ATS Ad Hoc Committee on Mild Obstructive Sleep Apnea (2016) An official American thoracic society research statement: impact of mild obstructive sleep apnea in adults. Am J Respir Crit Care Med 193:e37–e54

    Article  PubMed  Google Scholar 

  48. Norman JF, Von Essen SG, Fuchs RH, McElligott M (2000) Exercise training effect on obstructive sleep apnea syndrome. Sleep Res Online 3:121–129

    CAS  PubMed  Google Scholar 

  49. Xia Y, Fu Y, Wang Y, Qian Y, Li X, Xu H, Zou J, Guan J, Yi H, Meng L, Tang X, Zhu H, Yu D, Zhou H, Su K, Yin S (2017) Prevalence and predictors of atherogenic serum lipoprotein dyslipidemia in women with obstructive sleep apnea. Sci Rep 7:41687

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Silva LOE, Guimarães TM, Luz GP et al (2018) Metabolic Profile in Patients with Mild Obstructive Sleep Apnea. Metab Syndr Relat Disord 16(1):6–12

    Article  PubMed  CAS  Google Scholar 

  51. Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, Quinnell TG (2016) Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Med Rev 27:108–124

    Article  PubMed  Google Scholar 

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Funding

This study was funded by AFIP (Associação Fundo Incentivo à Pesquisa), CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior), FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo) grant number 2013-13916-3) and CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnologico) grant number 478965/2012-5.

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Authors and Affiliations

  1. Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, Vila Clementino, São Paulo, CEP 04021-002, Brazil

    Luciana Oliveira e Silva, Thais Moura Guimarães, Glaury Coelho, Sergio Tufik, Lia Bittencourt & Sonia Togeiro

  2. Departamento de Pneumologia, Universidade Federal de São Paulo, São Paulo, Brazil

    Gabriela Pontes, Luciana Badke & Sonia Togeiro

  3. Instituto do Sono, São Paulo, Brazil

    Cibele Dal Fabbro

  4. Center for Advanced Research in Sleep Medicine, Research Center of Faculty of Dental Medicine, Université de Montréal, Montréal, Canada

    Cibele Dal Fabbro

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  1. Luciana Oliveira e Silva
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  2. Thais Moura Guimarães
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  3. Gabriela Pontes
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  4. Glaury Coelho
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Correspondence to Sonia Togeiro.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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e Silva, L.O., Guimarães, T.M., Pontes, G. et al. The effects of continuous positive airway pressure and mandibular advancement therapy on metabolic outcomes of patients with mild obstructive sleep apnea: a randomized controlled study. Sleep Breath 25, 797–805 (2021). https://doi.org/10.1007/s11325-020-02183-1

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  • DOI: https://doi.org/10.1007/s11325-020-02183-1

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