Treatment of OSA using mandibular advancement versus CPAP in improving cardiovascular health

BACKGROUND Obstructive sleep apnea is a significant risk factor for hypertension. We assessed the relative effectiveness of mandibular advancement device (MAD) versus continuous Positive Airway Pressure (CPAP) in reducing 24-hour ambulatory blood pressure (BP) and other health-related outcomes over 12 months. METHODS In a randomized, non-inferiority trial, 321 participants with hypertension and increased cardiovascular risk were recruited for polysomnography. Of these, 220 with moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥15 events/hour) were randomized to MAD or CPAP (1:1). We report the final outcomes at the 12-month follow-up. RESULTS A total of 180 participants (MAD: 89; CPAP: 91) completed the 12-month follow-up. Median usage for MAD and CPAP was 5.5 and 4.9 hours per night, respectively. Compared to baseline, the 24-hour mean arterial BP at 12 months decreased by 2.3 mmHg ( P =0.200) in the MAD group and by 1.0 mmHg ( P =0.999) in the CPAP group. The difference between-groups was -0.6 mmHg (95% confidence interval: -2.53 to 1.39, non-inferiority P