The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment.

STUDY OBJECTIVES To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-h ambulatory blood pressure monitoring (ABPM) and peripheral arterial tonometry (PAT) at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in subgroup who had an AHI of < 5 and adherence of ≥ 4 hours per night (effective treatment subgroups). METHODS The inclusion criteria were individuals with mild OSA, any gender, aged between 18 and 65 years, with a BMI of ≤ 35Kg/m². Patients were randomized into CPAP, MAD and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-h ABPM and PAT at baseline, after 6 and 12 months. A generalized linear mixed model was used for comparisons. RESULTS The CPAP and MAD groups had lower AHIs than the control group at 6 and 12 months, and the CPAP group had higher SpO2 than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/per night; CPAP: 3.8 ± 3.4 h/per night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to PAT or 24-h ABPM outcomes. CONCLUSIONS Treatment of mild OSA with CPAP or MAD did not improve BP or endothelial function after one year, even in patients with effective treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, Title: Continuous Positive Airway Pressure and Oral Appliances Treatments in Mild Obstructive Sleep Apnea, Identifier: NCT01461486, URL: https://clinicaltrials.gov/ct2/show/NCT01461486.