Top

Sleep and Breathing

Published in:

01-09-2021 | Arterial Occlusive Disease | Sleep Breathing Physiology and Disorders • Original Article

Impact of mandibular advancement device therapy on cerebrovascular reactivity in patients with carotid atherosclerosis combined with OSAHS

Authors: Lu Qin, Na Li, Junyao Tong, Zeliang Hao, Lili Wang, Ying Zhao

Published in: Sleep and Breathing | Issue 3/2021

Abstract

Purpose

Obstructive sleep apnea-hypopnea syndrome (OSAHS) may affect cerebrovascular reactivity (CVR), representing cerebrovascular endothelial function, through complex cerebral functional changes. This study aimed to evaluate the change of CVR after 1-month and 6-month mandibular advancement device (MAD) treatment of patients with carotid atherosclerosis (CAS) combined with OSAHS.

Methods

Patients with carotid atherosclerosis combined with OSAHS who voluntarily accepted Silensor-IL MAD therapy were prospectively enrolled. All patients underwent polysomnographic (PSG) examinations and CVR evaluation by breath-holding test using transcranial Doppler ultrasound at baseline (T0), 1 month (T1), and 6 months (T2) of MAD treatment.

Results

Of 46 patients (mean age 54.4 ± 12.4 years, mean body mass index [BMI] 27.5 ± 4.5 kg/m²), 41 patients (responsive group) responded to the 1-month and 6-month treatment of MAD, an effective treatment rate of 89%. The remaining 5 patients (non-responsive group) were younger (47.4 ± 13.5 years) and had a higher BMI (35.8 ± 1.8 kg/m²). The responsive group had an improvement of apnea-hypopnea index (AHI) (events/h) from 33.0 ± 25.0 (T0) to 12.4 ± 10.4 (T1) and 8.7 ± 8.8 (T2), P < 0.001; minimum arterial oxygen saturation (minSpO₂) (%) increased from 79.8 ± 9.1 (T0) to 81.8 ± 9.4 (T1) and 85.2 ± 5.4 (T2), P < 0.01; longest apnea (LA) (s) decreased from 46.5 ± 23.1 (T0) to 33.3 ± 22.7 (T1) and 29.4 ± 18.5 (T2), P < 0.001; T90 (%) decreased from 10.3 ± 14.9 (T0) to 6.1 ± 11.8 (T1) and 3.3 ± 7.5 (T2), P < 0.05. Sleep architecture of these patients also improved significantly. The responsive group had a significant increase in left, right, and mean breath-holding index (BHI): left BHI(/s) from 0.52 ± 0.42 (T0) to 0.94 ± 0.56 (T1) and 1.04 ± 0.64 (T2), P < 0.01; right BHI(/s) from 0.60 ± 0.38 (T0) to 1.01 ± 0.58 (T1) and 1.11 ± 0.60 (T2), P < 0.01; mean BHI(/s) from 0.56 ± 0.38 (T0) to 0.97 ± 0.55 (T1) and 1.07 ± 0.59 (T2), P < 0.01), suggesting improved CVR.

Conclusion

Effective MAD therapy is beneficial for restoring cerebrovascular endothelial function in patients with CAS and OSAHS in a short period (1 month and 6 months).

Trial registration

Clinical trial registration number: NCT03665818. September 11, 2018.

Iyer SR, Iyer RR (2010) Sleep, aging and stroke-newer directions in management of stroke. J Assoc Physicians India 58:442–446PubMed

Beaudin AE, Waltz X, Hanly PJ, Poulin MJ (2017) Impact of obstructive sleep apnoea and intermittent hypoxia on cardiovascular and cerebrovascular regulation. Exp Physiol 102(7):743–763. https://doi.org/10.1113/EP086051CrossRefPubMed

Iftikhar IH, Bittencourt L, Youngstedt SD, Ayas N, Cistulli P, Schwab R, Durkin MW, Magalang UJ (2017) Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis. Sleep Med 30:7–14. https://doi.org/10.1016/j.sleep.2016.06.001CrossRefPubMed

Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ et al (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(8):879–887. https://doi.org/10.1164/rccm.201212-2223OCCrossRefPubMed

Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston SJ, de Bont LG et al (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 36(9):1289–1296. https://doi.org/10.5665/sleep.2948CrossRefPubMedPubMedCentral

Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G (2007) The effects of 1 year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest 131(3):740–749. https://doi.org/10.1378/chest.06-0965CrossRefPubMed

Trzepizur W, Gagnadoux F, Abraham P, Rousseau P, Meslier N, Saumet JL et al (2009) Microvascular endothelial function in obstructive sleep apnea: impact of continuous positive airway pressure and mandibular advancement. Sleep Med 10(7):746–752. https://doi.org/10.1016/j.sleep.2008.06.013CrossRefPubMed

Lin CC, Wang HY, Chiu CH, Liaw SF (2015) Effect of oral appliance on endothelial function in sleep apnea. Clin Oral Investig 19(2):437–444. https://doi.org/10.1007/s00784-014-1234-1CrossRefPubMed

Pretnar-Oblak J (2014) Cerebral endothelial function determined by cerebrovascular reactivity to L-arginine. Biomed Res Int 2014:601515. https://doi.org/10.1155/2014/601515CrossRefPubMedPubMedCentral

10.

Tsivgoulis G, Alexandrov AV (2008) Cerebral hemodynamics in acute stroke: pathophysiology and clinical implications. J Vasc Interv Neurol 1(3):65–69PubMedPubMedCentral

11.

Urback AL, MacIntosh BJ, Goldstein BI (2017) Cerebrovascular reactivity measured by functional magnetic resonance imaging during breath-hold challenge: a systematic review. Neurosci Biobehav Rev 79:27–47. https://doi.org/10.1016/j.neubiorev.2017.05.003CrossRefPubMed

12.

Oz O, Tasdemir S, Akgun H, Erdem M, Balikci A, Cetiz A, Yucel M, Ulas UH, Demirkaya S, Kutukcu Y, Özgen F (2017) Decreased cerebral vasomotor reactivity in patients with obstructive sleep apnea syndrome. Sleep Med 30:88–92. https://doi.org/10.1016/j.sleep.2016.09.020CrossRefPubMed

13.

Ponsaing LB, Lindberg U, Rostrup E, Iversen HK, Larsson H, Jennum P (2018) Impaired cerebrovascular reactivity in obstructive sleep apnea: a case-control study. Sleep Med 43:7–13. https://doi.org/10.1016/j.sleep.2017.10.010CrossRefPubMed

14.

Ryan CM, Battisti-Charbonney A, Sobczyk O, Mikulis DJ, Duffin J, Fisher A, Venkatraghavan L (2018) Evaluation of cerebrovascular reactivity in subjects with and without obstructive sleep apnea. J Stroke Cerebrovasc Dis 27(1):162–168. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.015CrossRefPubMed

15.

Wu PH, Rodríguez-Soto AE, Rodgers ZB, Englund EK, Wiemken A, Langham MC, Detre JA, Schwab RJ, Guo W, Wehrli FW (2020) MRI evaluation of cerebrovascular reactivity in obstructive sleep apnea. J Cereb Blood Flow Metab 40(6):1328–1337. https://doi.org/10.1177/0271678X19862182CrossRefPubMed

16.

Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katanick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler RE (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis-Society of Radiologists in Ultrasound Consensus Conference. Radiology 229(2):340–346. https://doi.org/10.1148/radiol.2292030516CrossRefPubMed

17.

Gao XM, Zeng XL, Fu MK, Huang XZ (2000) Mandible relocating in dental appliance treatment of obstructive sleep apnea syndrome. Chin J Orthodont 01:20–22

18.

Bruce CD, Steinback CD, Chauhan UV, Pfoh JR, Abrosimova M, Vanden BE et al (2016) Quantifying cerebrovascular reactivity in anterior and posterior cerebral circulations during voluntary breath holding. Exp Physiol 101(12):1517–1527. https://doi.org/10.1113/EP085764CrossRefPubMed

19.

Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. Journal of clinical sleep medicine 11(7):773–827. https://doi.org/10.5664/jcsm.4858CrossRefPubMedPubMedCentral

20.

Nakano H, Mishima K, Matsushita A, Suga H, Matsumura M, Mano T, Fukuda T, Hara H, Yamashita H, Ueyama Y (2013) Efficacy of the Silensor for treating obstructive sleep apnea syndrome. Oral Maxillofac Surg 17(2):105–108. https://doi.org/10.1007/s10006-012-0332-yCrossRefPubMed

21.

Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P (2008) Mandibular advancement appliance for obstructive sleep apnoea: results of a randomized placebo controlled trial using parallel group design. J Sleep Res 17(2):221–229. https://doi.org/10.1111/j.1365-2869.2008.00645.xCrossRefPubMed

22.

Koo BB, Wiggins R, Molina C (2012) REM rebound and CPAP compliance. Sleep Med 13(7):864–868. https://doi.org/10.1016/j.sleep.2012.03.019CrossRefPubMed

23.

Ryan S, Taylor CT, McNicholas WT (2009) Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Postgrad Med J 85(1010):693–698. https://doi.org/10.1136/thx.2008.105577CrossRefPubMed

24.

Portegies ML, de Bruijn RF, Hofman A, Koudstaal PJ, Ikram MA (2014) Cerebral vasomotor reactivity and risk of mortality: the Rotterdam Study. Stroke 45(1):42–47. https://doi.org/10.1161/STROKEAHA.113.002348CrossRefPubMed

25.

Sabayan B, Jansen S, Oleksik AM, van Osch MJ, van Buchem MA, van Vliet P et al (2012) Cerebrovascular hemodynamics in Alzheimer's disease and vascular dementia: a meta-analysis of transcranial Doppler studies. Ageing Res Rev 11(2):271–277. https://doi.org/10.1016/j.arr.2011.12.009CrossRefPubMed

26.

Nasr N, Traon AP, Czosnyka M, Tiberge M, Schmidt E, Larrue V (2009) Cerebral autoregulation in patients with obstructive sleep apnea syndrome during wakefulness. Eur J Neurol 16:386–391. https://doi.org/10.1111/j.1468-1331.2008.02501.xCrossRefPubMed

27.

Netzer NC (2010) Impaired nocturnal cerebral hemodynamics during long obstructive apneas: the key to understanding stroke in OSAS patients? SLEEP 33(2):146–147. https://doi.org/10.1093/sleep/33.2.146CrossRefPubMedPubMedCentral

28.

Foster GE, Hanly PJ, Ostrowski M, Poulin MJ (2007) Effects of continuous positive airway pressure on cerebral vascular response to hypoxia in patients with obstructive sleep apnea. Am J Respir Crit Care Med 175(7):720–725. https://doi.org/10.1164/rccm.200609-1271OCCrossRefPubMed

29.

Jiménez Caballero PE, Coloma Navarro R, Ayo Martín O, Segura Martín T (2013) Cerebral hemodynamic changes in obstructive sleep apnea syndrome after continuous positive airway pressure treatment. Sleep Breath 17(3):1103–1108. https://doi.org/10.1007/s11325-013-0810-yCrossRefPubMed

30.

Waltz X, Beaudin AE, Hanly PJ, Mitsis GD, Poulin MJ (2016) Effects of continuous positive airway pressure and isocapnic-hypoxia on cerebral autoregulation in patients with obstructive sleep apnoea. J Physiol 594(23):7089–7104. https://doi.org/10.1113/JP272967CrossRefPubMedPubMedCentral

31.

Wang Y, Xu H, Qian Y, Guan J, Yi H, Yin S (2017) Patients with obstructive sleep apnea display decreased flow-mediated dilatation: evidence from a meta-analysis. Med Sci Monit 23:1069–1082. https://doi.org/10.12659/msm.899716CrossRefPubMedPubMedCentral

32.

Cammaroto G, Costa F, Ruiz M, Andò G, Vicini C, Montevecchi F, Galletti C, Galletti F, Valgimigli M (2019) (2019). Obstructive sleep apnoea syndrome and endothelial function: potential impact of different treatment strategies-meta-analysis of prospective studies. Eur Arch Otorhinolaryngol 276(8):2331–2338. https://doi.org/10.1007/s00405-019-05486-6CrossRefPubMed

33.

Gagnadoux F, Pépin JL, Vielle B, Bironneau V, Chouet-Girard F, Launois S, Meslier N, Meurice JC, Nguyen XL, Paris A, Priou P, Tamisier R, Trzepizur W, Goupil F, Fleury B (2017) Impact of mandibular advancement therapy on endothelial function in severe obstructive sleep apnea. Am J Respir Crit Care Med 195(9):1244–1252. https://doi.org/10.1164/rccm.201609-1817OCCrossRefPubMed

34.

Qi JC, Zhang L, Li H, Zeng H, Ye Y, Wang T, Wu Q, Chen L, Xu Q, Zheng Y, Huang Y, Lin L (2019) Impact of continuous positive airway pressure on vascular endothelial growth factor in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 23(1):5–12. https://doi.org/10.1007/s11325-018-1660-4CrossRefPubMed

35.

Sanchez-de-la-Torre M, Campos-Rodriguez F, Barbe F (2013) Obstructive sleep apnea and cardiovascular disease. Lancet Respir Med 1(1):61–72. https://doi.org/10.1016/S2213-2600(12)70051-6CrossRefPubMed

36.

Tsivgoulis G, Alexandrov AV (2009) Cerebral autoregulation impairment during wakefulness in obstructive sleep apnea syndrome is a potential mechanism increasing stroke risk. Eur J Neurol 16(3):283–284. https://doi.org/10.1111/j.1468-1331.2008.02501.xCrossRefPubMed

37.

Labarca G, Campos J, Thibaut K, Dreyse J, Jorquera J (2019) Do T90 and SaO2 nadir identify a different phenotype in obstructive sleep apnea? Sleep Breath 23(3):1007–1010. https://doi.org/10.1007/s11325-019-01860-0CrossRefPubMed

38.

Bangash MF, Xie A, Skatrud JB, Reichmuth KJ, Barczi SR, Morgan BJ (2008) Cerebrovascular response to arousal from NREM and REM sleep. Sleep 31(3):321–327. https://doi.org/10.1093/sleep/31.3.321CrossRefPubMedPubMedCentral

Title: Impact of mandibular advancement device therapy on cerebrovascular reactivity in patients with carotid atherosclerosis combined with OSAHS
Authors: Lu Qin
Na Li
Junyao Tong
Zeliang Hao
Lili Wang
Ying Zhao
Publication date: 01-09-2021
Publisher: Springer International Publishing
Keyword: Arterial Occlusive Disease
Published in: Sleep and Breathing / Issue 3/2021
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-020-02230-x

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of mandibular advancement device therapy on cerebrovascular reactivity in patients with carotid atherosclerosis combined with OSAHS

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 3/2021

Effects of intranasal steroids on continuous positive airway pressure compliance among patients with obstructive sleep apnea

The rate of decrease in oxygen desaturation during severe obstructive sleep apnea syndrome is correlated with subjective excessive daytime sleepiness

Effect of continuous positive airway pressure on symptoms of anxiety and depression in patients with obstructive sleep apnea

The design of RIP belts impacts the reliability and quality of the measured respiratory signals

Efficacy of nasal masks versus nasal pillows masks during continuous positive airway pressure titration for patients with obstructive sleep apnea

Patients with obstructive sleep apnea have suppressed levels of soluble cytokine receptors involved in neurodegenerative disease, but normal levels with airways therapy

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page