Polecka Agnieszka, Nawrocki Jakub, Pulido Maria Alejandra, Olszewska Ewa
Department of Cardiology and Internal Medicine with Cardiac Intensive Care Unit, Doctoral School of the Medical University of Bialystok, Medical University of Bialystok, 15-089 Bialystok, Poland.
Clinic of Orthodontics, Wroclaw University Dental Center, Krakowska 26, 50-425 Wroclaw, Poland.
J Clin Med. 2024 Nov 10;13(22):6757. doi: 10.3390/jcm13226757.
Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive review aimed to explore the effects of MAD therapy on oxidative stress, inflammation, endothelial function, and its impact on the cardiovascular risk in OSA patients.
MAD therapy significantly reduces the apnea-hypopnea index (AHI), improves serum nitric oxide (NOx) concentrations, reduces oxidative stress markers, and enhances endothelial function. Animal studies indicated that MAD reduces myocardial fibrosis and attenuates inflammatory markers. While both CPAP and MADs improve endothelial function and heart rate variability, CPAP is more effective in reducing OSA severity. Nevertheless, MAD has higher compliance, contributing to its positive impact on cardiovascular function. Moreover, CPAP and MADs have similar effectiveness in reducing cardiovascular risk.
MAD therapy is an effective alternative to CPAP, particularly for patients with mild to moderate OSA as well as those intolerant to CPAP. It offers significant improvements in endothelial function and oxidative stress. Further studies are needed to assess MAD therapy in comprehensive OSA management.
阻塞性睡眠呼吸暂停综合征（OSA）是一种以血管内皮功能障碍和心血管并发症为特征的慢性炎症性疾病。持续气道正压通气（CPAP）是标准治疗方法，然而依从性差促使人们对下颌前移装置（MAD）作为一种替代方法产生兴趣。本综述旨在探讨MAD治疗对OSA患者氧化应激、炎症、内皮功能的影响及其对心血管风险的作用。
MAD治疗可显著降低呼吸暂停低通气指数（AHI），提高血清一氧化氮（NOx）浓度，降低氧化应激标志物水平，并增强内皮功能。动物研究表明，MAD可减轻心肌纤维化并降低炎症标志物水平。虽然CPAP和MAD均可改善内皮功能和心率变异性，但CPAP在降低OSA严重程度方面更有效。尽管如此，MAD的依从性更高，这对其心血管功能产生了积极影响。此外，CPAP和MAD在降低心血管风险方面具有相似的效果。
MAD治疗是CPAP的一种有效替代方法，尤其适用于轻度至中度OSA患者以及不耐受CPAP的患者。它在内皮功能和氧化应激方面有显著改善。需要进一步研究以评估MAD治疗在OSA综合管理中的作用。
