The Case for OAT in Hypertension Treatment

Every day I receive emails from sleep treatment providers especially in the dental field requesting articles that support various treatments or that support OAT for a particular disease. Most recently has been specifically requested.

Below I have attached 2 abstracts that are commonly referred to and included in sleep apnea treatment talks around the country. Hypertension is a regularly discussed comorbidity however not deeply covered in most OAT discussions.

In the first article the team studied patients who were diagnosed with baseline high blood pressure and who had sleep apnea. Oral Appliances were constructed that were advanced for one group and not advanced for a control group.  The patients were then studied for 24 hour with an ambulatory blood pressure monitor.

Ambulatory Bood Pressure Monitoring:  Ambulatory blood pressure (ABP) monitoring involves measuring blood pressure (BP) at regular intervals (usually every 20–30 minutes) over a 24 hour period while patients undergo normal daily activities, including sleep. The portable monitor is worn on a belt connected to a standard cuff on the upper arm and uses an oscillometric technique to detect systolic, diastolic and mean BP as well as heart rate.1 When complete, the device is connected to a computer that prepares a report of the 24 hour, day time, night time, and sleep and awake (if recorded) average systolic and diastolic BP and heart rate.”

blood pressure

Interesting to note in the summary that if in the patient selection phase the patient had an AHI greater than 15 the oral appliance had a greater impact on the patients BP.

The second article was more long term it looks at the long term efficacy of OAT for hypertensives. The study showed that patients with hypertension who responded to oral appliance therapy were well treated in 3 month and 3 year intervals.

I hope these two articles help you with your talks. If you have an article you think is better or perhaps want to comment on the use of these articles please let me know.

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

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.

Sleep Breath. 2013 May;17(2):705-12. doi: 10.1007/s11325-012-0746-7. Epub 2012 Jul 21

Effects on blood pressure after treatment of obstructive sleep apnea with a mandibular advancement appliance – a three-year follow-up

Andrén ASjöquist MTegelberg A.

Department of Stomatognathic Physiology, Central Hospital, SE-721 89 Västerås, Sweden. ann.andren@bredband.net

Abstract

Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder; it affects 4% of males and 2% of females. Elevated blood pressure, Hypertension has been shown to occur in 28-57% of OSA patients. There is a steady increase in evidence linking OSA to long-term cardiovascular morbidity including hypertension. The purpose of this study was to investigate whether mandibular advancement oral appliance (OA) treatment of OSA affects the patient’s blood pressure (BP) in a 3-month and a 3-year perspective. Twenty-nine consecutive patients, with verified OSA defined as apnoea index (AI) >5 per hour and/or apnoea/hypopnoea index (AHI) > or =10 per hour, received an OA as treatment. BP was measured on three occasions; before treatment, after 3 months of treatment, and after 3 years of treatment. BP was measured with an electronic blood pressure monitor. The treatment effect of OA was measured after 3 months by repeated somnographic registration while the patient was wearing the OA. A treatment response was defined as AHI < 10; this was achieved in 25 of 29 patients (86%) at the 3-month evaluation. Significant reductions in blood pressure were attained between baseline and the 3-month evaluation (P < 0.001) and these changes remained at the 3-year follow-up in both systolic BP of -15.4 +/- 18.7 mm Hg and diastolic BP of -10.3 +/- 10.0 mm Hg. OA therapy reduced blood pressure in both a 3-month and a 3-year perspective in patients with OSA.

J Oral Rehabil. 2009 Oct;36(10):719-25. Epub 2009 Aug 12

Randy Clare

Randy Clare

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of a Sleep Bruxism Monitor in a dental office. Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders. Mr Clare is a senior brand manager for Glidewell Dental Laboratory his focus is on dental treatment for sleep disordered breathing.

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