0
Original Research: SLEEP MEDICINE |

Autonomic Cardiac Modulation in Obstructive Sleep Apnea*: Effect of an Oral Jaw-Positioning Appliance

Paolo Coruzzi, MD; Massimo Gualerzi, MD; Edoardo Bernkopf, MD; Lorenzo Brambilla, MD; Valerio Brambilla, MD; Vanna Broia, MD; Carolina Lombardi, MD; Gianfranco Parati, MD
Author and Funding Information

*From Fondazione Don C. Gnocchi – ONLUS (Drs. Gualerzi, L. Brambilla, and V. Brambilla), Department of Clinical Sciences (Dr. Coruzzi), University of Parma, Parma; Consultant Orthodontic (Drs. Bernkopf and Broia), Parma; and Department of Clinical Medicine, Prevention and Applied Biotechnologies (Drs. Lombardi and Parati), Milano, Italy.

Correspondence to: Massimo Gualerzi, MD, Fondazione Don C. Gnocchi – ONLUS, Fondazione Don C. Gnocchi, Piazzale dei Servi n° 3, I 43100, Parma, Italy; e-mail: gualerzimassimo@hotmail.com



Chest. 2006;130(5):1362-1368. doi:10.1378/chest.130.5.1362
Text Size: A A A
Published online

Background: Patients with obstructive sleep apnea (OSA) are characterized by deranged cardiovascular variability, a well-established marker of cardiovascular risk. While long-term treatment with continuous positive airway pressure leads to a significant improvement of cardiovascular variability, little is known of the possibility of achieving the same results with other therapeutic approaches. The aim of our study was to investigate the responses of autonomic indexes of neural cardiac control to another type of OSA treatment based on an oral jaw-positioning appliance.

Methods: In 10 otherwise healthy subjects with OSA (OSA+) and in 10 subjects without OSA (OSA−) we measured heart rate, BP, and indices of autonomic cardiac regulation derived from time-domain and spectral analysis of R-R interval (RRI), before and after 3 months of treatment with the oral device. High-frequency (HF) power of RRI was taken as an index of parasympathetic cardiac modulation, and the ratio between low-frequency (LF) and HF RRI powers as an indirect marker of the balance between sympathetic and parasympathetic cardiac modulation.

Results: At baseline, in comparison with OSA− subjects, OSA+ subjects displayed a significantly lower RRI variance (p < 0.02) and reduced HF RRI powers (p < 0.001). After 3 months of treatment with the oral device, the OSA+ group showed a marked reduction in apnea-hypopnea index (p < 0.001), a lengthening in RRI and a significant increase in its variance (p < 0,02), an increased HF RRI power (from 134 ± 26 to 502 ± 48 ms2, p < 0.001), and a reduction in LF/HF RRI power ratio (from 3.11 ± 0.8 to 1.5 ± 0.5). As a result of these changes, after the 3-month treatment there were no more significant differences between the two groups in these parameters. In both OSA+ and OSA− groups, body weight, heart rate, and BP did not change over time.

Conclusions: Three months of treatment with a specific oral jaw-positioning appliance improves cardiac autonomic modulation in otherwise healthy patients with OSA of mild degree.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543