期刊
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
卷 187, 期 8, 页码 879-887出版社
AMER THORACIC SOC
DOI: 10.1164/rccm.201212-2223OC
关键词
obstructive sleep apnea; continuous positive airway pressure; mandibular advancement device; health outcomes; efficacy and compliance
资金
- Australian National Health and Medical Research Council [457557, 202916, 571179]
- CIRUS Postdoctoral Fellowship from the Australian National Health and Medical Research Council
Rationale: Continuous positive airway pressure (CPAP) and mandibular advancement device (MAD) therapy are commonly used to treat obstructive sleep apnea (OSA). Differences in efficacy and compliance of these treatments are likely to influence improvements in health outcomes. Objectives: To compare health effects after 1 month of optimal CPAP and MAD therapy in OSA. Methods: In this randomized crossover trial, we compared the effects of 1 month each of CPAP and MAD treatment on cardiovascular and neurobehavioral outcomes. Measurements and Main Results: Cardiovascular (24-h blood pressure, arterial stiffness), neurobehavioral (subjective sleepiness, driving simulator performance), and quality of life (Functional Outcomes of Sleep Questionnaire, Short Form-36) were compared between treatments. Our primary outcome was 24-hour mean arterial pressure. A total of 126 patients with moderate-severe OSA (apnea hypopnea index [AHI], 25.6 [SD 12.3]) were randomly assigned to a treatment order and 108 completed the trial with both devices. CPAP was more efficacious than MAD in reducing AHI (CPAP AHI, 4.5 +/- 6.6/h; MAD AHI, 11.1 +/- 12.1/h; P < 0.01) but reported compliance was higher on MAD (MAD, 6.50 +/- 1.3 h per night vs. CPAP, 5.20 +/- 2 h per night; P < 0.00001). The 24-hour mean arterial pressure was not inferior on treatment with MAD compared with CPAP (CPAP-MAD difference, 0.2 mm Hg [95% confidence interval, -0.7 to 1.1]); however, overall, neither treatment improved blood pressure. In contrast, sleepiness, driving simulator performance, and disease-specific quality, of life improved on both treatments by similar amounts, although MAD was superior to CPAP for improving four general quality-of-life domains. Conclusions: Important health outcomes were similar after 1 month of optimal MAD and CPAP treatment in patients with moderate-severe OSA. The results may be explained by greater efficacy of CPAP being offset by inferior compliance relative to MAD, resulting in similar effectiveness. Clinical trial registered with https://www.anzctr.org.au (ACTRN 12607000289415).
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据