Eur J Prev Cardiol. 2026 Jun 12:zwag297. doi: 10.1093/eurjpc/zwag297. Online ahead of print.
ABSTRACT
AIMS: To determine whether baseline atherosclerotic cardiovascular disease (ASCVD) modifies the blood pressure (BP) response to mandibular advancement device (MAD) vs. continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA).
METHODS AND RESULTS: This prespecified secondary analysis of the CRESCENT randomized controlled trial included adults with moderate-to-severe OSA and elevated cardiovascular risk, randomized 1:1 to MAD or CPAP. Outcomes were evaluated according to ASCVD status. The primary outcome was the between-group difference in 24-h ambulatory BP at 6 months. Analyses used ANCOVA models adjusted for baseline BP, with treatment-by-ASCVD interaction testing. Secondary outcomes included excessive daytime sleepiness and circulating cardiovascular biomarkers. Among the 220 participants (median age 61 years, 85.5% male), 145 (66%) had ASCVD. In the ASCVD group, MAD was associated with greater reductions than CPAP in 24-h systolic BP (-3.41 mmHg; 95% CI -6.56 to -0.27; P = 0.028), 24-h mean BP (-2.50 mmHg; 95% CI -4.90 to -0.11; P = 0.040), asleep systolic BP (-5.13 mmHg; 95% CI -9.36 to -0.91; P = 0.018), and asleep mean BP (-3.97 mmHg; 95% CI -7.31 to -0.62; P = 0.021). No significant between-treatment differences were observed in the non-ASCVD group. A significant treatment-by-ASCVD interaction was observed for asleep systolic BP (P = 0.034). Treatment effects on daytime sleepiness and cardiovascular biomarkers were similar across ASCVD subgroups and across treatment groups.
CONCLUSION: In patients with OSA and ASCVD, MAD was associated with greater reductions in ambulatory BP than CPAP. Formal evidence of differential treatment effect by ASCVD status was strongest for asleep systolic BP. These findings suggest that patients with OSA and ASCVD may derive greater BP benefit from MAD compared with CPAP.
PMID:42284153 | DOI:10.1093/eurjpc/zwag297