Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea.

Study objectives Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure (CPAP) partially reverse this hypertrophy, but data regarding the effect of mandibular advancement devices (MAD) on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of MAD therapy on LV geometry and function in patients with OSA. Methods At baseline and 6-month follow-up, participants underwent a home sleep apnea test (HSAT), 24-hour ambulatory blood pressure (BP) monitoring and a 2D Doppler and tissue Doppler echocardiography. Results Sixty-three patients (age: 49 ± 11 years; BMI: 27.0 ± 3.4 kg/m2; baseline AHI-HSAT: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, BP values and parameters of LV function were within normal ranges at baseline and did not change under MAD therapy. In contrast, the interventricular septum (IVS) thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs. 10.6 ± 2.0 mm, p = 0.03). This significant improvement is only found in responders but not in non-responders. There was no correlation between the decrease of IVS thickness and the change in BP. Conclusions In this mildly obese, normotensive patients with OSA, we observed significant reverse hypertrophic remodeling after 6 months of successful MAD therapy, with maintained normotensive systemic BP. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients.