TREATMENT WITH MANDIBULAR ADVANCEMENT DEVICES IN COMORBID INSOMNIA AND SLEEP APNEA

Abstract

Introduction: Comorbid insomnia and sleep apnea (COMISA) is a prevalent and clinically significant condition associated with increased cardiometabolic risk. This study aimed to evaluate treatment with mandibular advancement oral appliances (OAm) in COMISA patients by assessing its impact on sleep-disordered breathing, insomnia severity, and autonomic nervous system modulation. Methods: A retrospective multicentric case-control study was conducted, comprising two cohorts. Cohort 1 included patients diagnosed with OSA (n=35) or COMISA (n=31) who underwent OAm therapy. Cohort 2 consisted of 12 COMISA patients treated with a titratable OAm. Clinical, polysomnographic, and heart rate variability (HRV) measures were assessed pre- and post-treatment. HRV analyses were conducted using time-domain and frequency-domain parameters, including fast Fourier transform and wavelet spectral methods. Results: In Cohort 1, post-treatment apnea-hypopnea index (AHI) improved significantly in both OSA and COMISA groups, but COMISA patients retained a slightly elevated residual AHI (6.4±6.9 vs. 3.7±3.2 events/hour; p=0.04). Sleep latency in COMISA patients decreased significantly from 63.6±46.0 min to 22.8±20.8 min (p=0.001). In Cohort 2, AHI decreased from 22.7±12.7 to 4.0±3.5 events/hour (p<0.0002), oxygen desaturation index (ODI) improved from 18.8±14.0 to 3.5±2.0 events/hour (p<0.02), and sleep latency improved from 63.1±49.4 to 21.8±21.4 min (p<0.02). HRV analyses demonstrated increased parasympathetic activity and reduced sympathetic dominance post-treatment. Conclusion: OAm therapy reduced the severity of sleep-disordered breathing and ameliorated insomnia symptoms in COMISA patients. Additionally, HRV improvements suggest potential cardiovascular benefits. These findings support the consideration of OAm as a viable therapeutic option for COMISA management, warranting further investigation through prospective controlled trials.