A randomized, non-inferiority trial in Singapore showed that mandibular advancement device (MAD) was non-inferior to continuous positive airway pressure (CPAP) for reducing 24-hour mean arterial blood pressure (BP) in patients with high BP and obstructive sleep apnea (OSA). The trial randomized 220 participants with moderate-to-severe OSA (apnea–hypopnea index AHI ≥15 events/hour, median age 61-62, 84-87% men, median body mass index 27-28) to either MAD or CPAP. Compared to baseline, the 24-hour mean arterial BP decreased significantly by 2.5 mmHg (P = 0.003) at 6 months in the MAD group but not in the CPAP group. The between-group difference was -1.6 mmHg (non-inferiority P < 0.001). The MAD group demonstrated a longer MAD usage and a larger between-group reduction in all secondary ambulatory BP parameters compared to the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with similar between-group differences. There were no between-group differences in cardiovascular biomarkers. OSA is an under-diagnosed and modifiable cause of high BP. Guidelines recommend screening and treatment of OSA in patients with high BP. CPAP is the first-line treatment for OSA, although many patients either decline to use CPAP or find it challenging to stick to it. The MAD has great potential for a public health impact. Source: https://www.jacc.org/
