Changes on sleep quality after treatment of mandibular advance device for sleep apnea: 24 h holter-based cardiopulmonary coupling analysis

Abstract

Background: The purpose of this study is to report the treatment effects of mandibular advance device (MAD) on patients with sleep apnea based on cardiopulmonary coupling (CPC) analysis.

Method: Patients with mild to moderate obstructive sleep apnea were enrolled in a prospective, single-center study. All patients were diagnosed with obstructive sleep apnea (OSA) after full-night polysomnography and underwent 24 h Holter monitoring before and after 6-month treatment of MAD. We evaluated sleep quality using cardiopulmonary coupling analysis based on Holter monitoring. Change from baseline was analyzed using Wilcoxon signed rank test.

Results: Of 23 patients, total 12 subjects were included (8 refused to Holter monitoring and 3 diagnosed with atrial fibrillation). Mean age and apnea-hypopnea index were 55.2 ± 8.19 years and 18.9 ± 4.6/h, respectively. In CPC analysis, no significant changes were observed after MAD treatment in the high-frequency coupling ratio (marker of stable sleep; 33.7%–29.9%, p 0.37), the low-frequency coupling ratio (marker of unstable sleep; 38.3%–39.8%,p0.75), narrow band ratio (marker of sleep-disordered breathing; 1.9%–2.5%, p 0.51) ratio and the very-low-frequency coupling ratio (marker of rapid eye movement/waker; 27.6%–29.6%, p 0.48).

Conclusion: In this study for short-term period, we could not determine beneficious effect of MAD in CPC parameters among patients with sleep apnea.