Blood pressure response with obstructive sleep apnoea treatment: mandibular advancement device versus continuous positive airway pressure

INTRODUCTION: Obstructive sleep apnea (OSA) is a treatable risk factor for hypertension. Continuous Positive Airway Pressure (CPAP) and mandibular advancement devices (MAD) are effective treatments for OSA and have been shown to improve blood pressure in OSA. AREAS COVERED: This review explores the role of CPAP and MAD in the treatment of OSA for blood pressure control. Important clinical phenotypes associated with improved blood pressure in OSA are explored. A PubMed search of relevant articles within the past 10-years was performed. EXPERT OPINION: OSA therapy is shifting from a one-size-fits-all toward a precision medicine approach. Both CPAP and MAD have been demonstrated to reduce blood pressure in selected OSA patients. Neutral randomized controlled trials add to the uncertainty of treating OSA for the reduction of cardiovascular risk. Further work is needed to identify individual patients who are likely to gain a cardiovascular benefit from OSA treatment, including a reduction in blood pressure. Recent advances in wearable devices and sensor technologies present exciting opportunities for improving patient compliance with OSA therapy, monitoring long-term outcomes, and informing precision medicine approaches in clinical practice to improve blood pressure management in OSA.