Comparative effects of CPAP and Mandibular Advancement Device Treatment on Cardiac Structure and Function in OSA: A Cardiovascular Magnetic Resonance Randomised Controlled Study
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Background
Adverse cardiac remodelling, including left ventricular (LV) hypertrophy, LV dysfunction and diffuse myocardial fibrosis, is observed in obstructive sleep apnoea (OSA). However, the impact of OSA treatment on cardiac remodelling remains poorly defined. The Cardiosleep Research Program on Obstructive Sleep Apnoea, Blood Pressure Control and Maladaptive Myocardial Remodeling—Non-inferiority Trial (CRESCENT) showed that treatment with a mandibular advancement device (MAD) was non-inferior to continuous positive airway pressure (CPAP) for reducing 24-hour mean arterial BP in patients with hypertension and moderate-to-severe OSA, after 6 months of treatment. This cardiovascular magnetic resonance (CMR) substudy of the CRESCENT trial aimed to evaluate the comparative effects of MAD and CPAP on myocardial structure and function in patients with OSA.
Methods
85 patients with hypertension, increased cardiovascular risk and newly-diagnosed moderate- to-severe OSA (Apnoea-Hypopnoea Index [AHI] ≥15 events/hour), underwent contrast-enhanced CMR at baseline and following 12 months of treatment with CPAP (n=49) or MAD (n=36). LV mass, volumes, function and markers of diffuse myocardial fibrosis, including the extracellular volume (ECV) fraction and interstitial volume, were measured.
Results
Across the cohort (age: 61[54–66] years, 91% males, BMI: 28[26–31] kg/m 2 , and AHI: 41[27–59] events/hour), a modest reduction in the ECV fraction was observed (25.0±2.0 vs 24.3±2.0%; p<0.001), accompanied by a reduction in the interstitial volume over a 12-month period of OSA treatment (24.0[21.3-27.7] vs 23.3[20.4-27.4]mL; p=0.044). The reduction in ECV fraction was similar between the CPAP and MAD groups (p=0.94).
Conclusion
12 months treatment of OSA in patients with hypertension is associated with a reduction in myocardial ECV fraction, a surrogate marker of diffuse myocardial fibrosis, with accompanying reduction in myocardial interstitial volume. Both CPAP and MAD were similarly effective. Further confirmation of these findings in larger cohorts is warranted. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling—Non-inferiority Trial [CRESCENT]; NCT04119999 ).
