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

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.