Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea

Marijke Dieltjens; Olivier M Vanderveken; Bharati Shivalkar; Gilles Van Haesendonck; Chloé Kastoer; Hein Heidbuchel; Marc J Braem; Caroline M Van De Heyning

doi:10.5664/jcsm.9766

Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea

J Clin Sleep Med. 2022 Mar 1;18(3):903-909. doi: 10.5664/jcsm.9766.

Authors

Marijke Dieltjens^{1

2}, Olivier M Vanderveken^{1

2}, Bharati Shivalkar^{1

3

4}, Gilles Van Haesendonck^{1

2}, Chloé Kastoer^{1

2}, Hein Heidbuchel^{1

5}, Marc J Braem^{1

2}, Caroline M Van De Heyning^{1

5}

Affiliations

¹ Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
² Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
³ Department of Cardiology, Delta (CHIREC) Hospital, Brussels, Belgium.
⁴ Pfizer Biopharmaceuticals, Brussels, Belgium.
⁵ Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium.

Abstract

Study objectives: Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure partially reverses this hypertrophy, but data regarding the effect of mandibular advancement devices on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of mandibular advancement device therapy on LV geometry and function in patients with OSA.

Methods: At baseline and 6-month follow-up, participants underwent a home sleep apnea test, 24-hour ambulatory blood pressure monitoring and a 2-dimensional Doppler and tissue Doppler echocardiography.

Results: Sixty-three patients (age: 49 ± 11 years; body mass index: 27.0 ± 3.4 kg/m²; baseline apnea-hypopnea index home sleep apnea test: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, blood pressure values and parameters of LV function were within normal ranges at baseline and did not change under mandibular advancement device therapy. In contrast, the interventricular septum thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs 10.6 ± 2.0 mm, P = .03). This significant improvement is only found in responders but not in nonresponders. There was no correlation between the decrease of interventricular septum thickness and the change in blood pressure.

Conclusions: In mildly obese, normotensive patients with OSA we observed significant reverse hypertrophic remodeling after 6 months of successful mandibular advancement device therapy, with maintained normotensive systemic blood pressure. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Evaluation of the Cardiovascular Effects of the MAS in the Treatment of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02320877; Identifier: NCT02320877.

Citation: Dieltjens M, Vanderveken OM, Shivalkar B, et al. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):903-909.

Keywords: cardiovascular aspects; hypertrophic remodeling; mandibular advancement treatment.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Pressure Monitoring, Ambulatory
Continuous Positive Airway Pressure
Humans
Hypertrophy
Mandibular Advancement* / methods
Middle Aged
Occlusal Splints
Prospective Studies
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / diagnostic imaging
Sleep Apnea, Obstructive* / therapy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT02320877