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Effectiveness of sleep surgery versus a mandibular advancement device for obstructive sleep apnea in terms of nocturnal cardiac autonomic activity

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Abstract

Purpose

Sleep surgery and mandibular advancement devices (MAD) are treatments for obstructive sleep apnea (OSA), but their comparative efficacy remains unclear. We compared their efficacy using various parameters.

Methods

Subjects treated for OSA with sleep surgery or MAD (n = 30/group)—matched for sex, body mass index (BMI), and baseline apnea–hypopnea index (AHI)—were enrolled. The efficacy of these treatments according to polysomnographic parameters, sleep quality questionnaires, and heart rate variability (HRV) time- and frequency-domain parameters were compared between pre-treatment and 3-month post-treatment.

Results

Polysomnographic and sleep quality questionnaire parameters improved significantly in both groups. In time-domain HRV analysis, average normal-to-normal intervals increased significantly in the surgery (942.2 ± 140.8 to 994.6 ± 143.1, P = 0.008) and MAD (901.1 ± 131.7 to 953.7 ± 123.1, P = 0.002) groups. Low frequency (LF) decreased significantly in the surgery group (P = 0.012); high frequency (HF) remained unchanged in both groups. The LF/HF ratio decreased in both groups (2.9 ± 1.8 to 2.3 ± 1.7, P = 0.017, vs. 3.0 ± 1.8 to 2.4 ± 1.4, P = 0.025). Normalized high frequency increased significantly in both groups (31.0 ± 13.2 to 36.8 ± 13.7, P = 0.009, vs. 29.1 ± 10.7 to 33.7 ± 12.5, P = 0.024), in contrast to normalized low frequency. However, no HRV parameter changes differed significantly between the groups after adjusting for age, BMI, and AHI.

Conclusion

Sleep surgery and MAD are equally effective treatments for OSA according to cardiac autonomic activity.

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Funding

This study was funded by 2019 Kangwon National University Hospital Grant (#2019-02-004), SNUBH grant (#18-2018-013), and the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (# NRF-2015M3A9D7066973).

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Authors and Affiliations

  1. Department of Otolaryngology, Kangwon National University Hospital, Chuncheon, South Korea

    Woo Hyun Lee

  2. Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, South Korea

    Sung Ok Kwon

  3. Department of Otorhinolaryngology, Seoul National University Bundang Hospital, 82 Gumi-ro 173th street, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Jeong-Whun Kim

  4. Seoul National University College of Medicine, Seoul, South Korea

    Jeong-Whun Kim

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  1. Woo Hyun Lee
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Correspondence to Jeong-Whun Kim.

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Lee, W.H., Kwon, S.O. & Kim, JW. Effectiveness of sleep surgery versus a mandibular advancement device for obstructive sleep apnea in terms of nocturnal cardiac autonomic activity. Sleep Breath 24, 1695–1703 (2020). https://doi.org/10.1007/s11325-020-02048-7

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  • DOI: https://doi.org/10.1007/s11325-020-02048-7

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