The most serious health effect of sleep apnea is the damage and deterioration of the cardiovascular system. Heart damage, hardened arteries, and increased stroke risk are among the effects of sleep apnea, but the most easily detectable sign of impending cardiovascular injury is high blood pressure (hypertension).
The presence of high blood pressure is a warning sign of sleep apnea, and reducing blood pressure is often a sign of successful sleep apnea treatment. Now a new review of studies shows that oral appliances are as effective as CPAP in lowering blood pressure.
A Large Meta-Review
One of the limiting problems with studies on CPAP and oral appliances is that they tend to be smaller studies, typically with fewer than 100 patients. It’s hard to get good data about the relative effectiveness of these two treatments with so few patients.
One way to get around this limitation is to use a meta-review. In a meta-review, the data from many studies is brought together and analyzed to answer questions that the individual studies don’t do as well.
For this new review, a total of 51 studies covering a total of nearly 5000 patients were analyzed. The distribution of studies showed how much more research has been done on CPAP than oral appliances: 44 of the studies were comparing CPAP to an inactive control, while only three compared oral appliances to an inactive control, only one compared CPAP to oral appliances, and a final three compared CPAP, oral appliances, and an inactive control.
The data revealed that CPAP treatment resulted in reductions of 2.5 mm Hg of systolic blood pressure (SBP), and 2.0 mm Hg diastolic blood pressure (DBP). Oral appliances reduced SBP by 2.1 mm Hg and DBP by 1.9 mm Hg. Even with the relatively large study, these differences were found to be statistically indistinguishable.
Which Treatment Works for You?
If these two treatments are essentially identical in their treatment outcomes, the most important question becomes which treatment will you actually use? For many people, CPAP is just too hard to use. It is uncomfortable, inconvenient, and confining. Oral appliances offer a more comfortable and more convenient option. Given the choice, many people would prefer oral appliances.