Perspectives on the reduction in cardiovascular mortality with oral appliance therapy for patients with severe obstructive sleep apnoea intolerant to continuous positive airway pressure

摘要

Obstructive sleep apnoea (OSA) is a well-established and independent risk factor for a range of clinical conditions, such as hypertension, stroke and diabetes. Severe OSA (apnoea/hypopnoea index > 30/h) significantly increases the risk of cardiovascular mortality.Continuous positive airway pressure (CPAP) is considered the standard of care for patients with severe OSA,and an effective treatment with CPAP reduces the risk of OSA-related cardiovascular morbidity and mortality. Oral appliance therapy, particularly with appliances that reduce upper airway collapse by advancing the mandible (OA_m), is indicated for the management of patients with mild to moderate OSA, and can be prescribed as a second-line treatment for patients with severe OSA who do not comply with or refuse CPAP. In literature, there is increasing evidence for the beneficial effect of OA_m therapy on OSA-related cardiovascular morbidity.