Scoping Review Protocol: The Effect of Mandibular Advancement Devices on the Autonomic Nervous System in Obstructive Sleep Apnea Patients

  • Scoping Review Protocol: The Effect of Mandibular Advancement Devices on Autonomic Dysfunction in Obstructive Sleep Apnea

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  •  Obstructive sleep apnea (OSA) is a type of disordered breathing defined by repetitive airflow obstruction during sleep due to upper airway collapse. Each obstructive event contributes to decreased blood oxygen (i.e., hypoxia). OSA is associated with vascular damage and dysfunction of the cardiac autonomic nervous system. The degree of hypoxia plays a role in the development of cardiac autonomic dysfunction and has been associated with an increased risk of sudden cardiac death. As a result, OSA is strongly and independently associated with increased cardiovascular mortality, stroke, heart failure and arrhythmia.Continuous positive airway pressure (CPAP) is the most accepted treatment for OSA. Unfortunately, fewer than 50% of patients adhere to CPAP therapy over the long-term. Mandibular advancement devices (MAD) are an accepted alternative treatment and despite their decreased efficacy in lowering hypoxic events, they are suggested to improve disease progression through increased compliance compared to CPAP. Further research is needed to understand the effect of MADs on the cardiac autonomic nervous system.
     Increased sympathetic nervous activity (SNA) is a type of cardiac autonomic dysfunction observed even in mild OSA. Increased SNA is a cause of hypertension which may also increase subsequent cardiovascular risk in OSA. To our knowledge, no studies exist directly measuring SNA in a MAD intervention with microneurography. However, heart rate variability (HRV) has been used to reflect cardiac autonomic modulation indirectly during MAD interventions. Our purpose is to conduct a scoping review to map the direct and indirect techniques used to measure autonomic nervous activity in OSA patients managed with MAD therapy. Secondly, we aim to assess the extent of current knowledge regarding changes in SNA in patients using MADs and determine the appropriateness of a systematic review of the topic. 

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    Attribution-NonCommercial-NoDerivatives 4.0 International