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The Effect of Mandibular Advancement Devices on Sympathetic Nerve Activity and Markers of Cardiovascular Health in Obstructive Sleep Apnea Patients: A Feasibility Trial
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- Author / Creator
- King, Emily
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OBJECTIVE: To determine whether mandibular advancement device (MAD) therapy improves sympathetic nerve activity (SNA) in mild to moderate adult OSA patients, or in those with severe OSA who cannot tolerate CPAP. Secondarily, we will investigate whether MAD therapy improves vascular health and indirect markers of SNA (heart rate variability and concentrations of noradrenaline in the blood).HYPOTHESIS: There will be a significant reduction in SNA and improvement in blood vessel health in mild to moderate OSA patients who are compliant with and respond to MAD therapy.DESIGN: This feasibility trial is a prospective case series examining subjects at baseline, three months and again at six months after a MAD intervention. Participants were referred by dental providers who are certified to provide MAD therapy. The following outcomes were recorded at each time point: muscle sympathetic nerve activity (MSNA), heart rate, blood pressure, flow-mediated dilation (FMD; a marker of vascular health), blood noradrenaline, apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) via a take-home sleep study, and MAD compliance via a scorecard for self-reported nighttime wear.METHODOLOGY: The participants were seated in a chair reclined at 45 degrees. Blood was drawn to measure the concentration of noradrenaline in the blood as an indirect measure of SNA. Next, participants were instrumented with an ECG, finometer, and blood pressure cuff. Next, a trained technician recorded multi-unit postganglionic MSNA via microneurography, which involves the insertion of a sterile tungsten recording microelectrode into a muscle nerve fascicle of a sympathetic nerve bundle in the peroneal nerve. MSNA was obtained through manipulation of the microelectrode until a characteristic nerve recording pattern was observed. Following instrumentation, the participant rested quietly for 10 minutes while MSNA, beat-by-beat blood pressure and heart rate data were recorded for 10 minutes. After 10 minutes, a standardized test, known as flow-mediated dilation (FMD) began to assess endothelial function as a marker of vascular health. Participants were sent home with a take-home sleep study to measure AHI and ODI for the categorization of patients according to MAD response for data analysis. Participants also kept a scorecard of the number of hours the MAD was worn per night for each 3-month interval between time points.CONCLUSION: Descriptive statistics are presented (n=4), and suggestions to enhance future trial feasibility are discussed.
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- Graduation date
- Fall 2023
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- Type of Item
- Thesis
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- Degree
- Master of Science
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- License
- This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.