Effects of mandibular advancement device versus continuous positive airway pressure on cardiac remodeling in obstructive sleep apnea: a randomized CMR substudy
12 affiliations
- 1Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
- 2National Heart Research Institute of Singapore, National Heart Centre Singapore, Singapore, Singapore
- 3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- 4Cardiovascular Sciences ACP, Duke NUS Medical School, Singapore, Singapore
- 5Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- 6Department of Otolaryngology–Head & Neck Surgery, National University Hospital, Singapore, Singapore
- 7Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
- 8Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW Australia
- 9Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- 10Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
- 11Department of Cardiology, National University Heart Centre, Singapore, Singapore
- 12Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 169609 Singapore, Singapore
Abstract
Obstructive sleep apnea (OSA) is associated with adverse cardiac remodeling, including diffuse myocardial fibrosis. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, while mandibular advancement devices (MAD) may represent an alternative. However, their comparative effects on myocardial structure remain incompletely defined. To compare the effects of MAD and CPAP on cardiac remodeling assessed by cardiovascular magnetic resonance (CMR) in patients with OSA. This prespecified CMR substudy of the randomized CRESCENT trial included patients who agreed to participate in both baseline and 12-month CMR examinations (aged 59±8 years, 89% male, with hypertension, elevated cardiovascular risk and moderate-to-severe OSA). The mean body mass index was 28.6±4.6 kg/m2. Participants underwent contrast-enhanced CMR at baseline and after 12 months of treatment with either MAD (n = 36) or CPAP (n = 49). CMR-derived measures included left ventricular (LV) mass, cardiac volumes and function; and extracellular volume (ECV) fraction as a marker of diffuse myocardial fibrosis. At baseline, mean 24-hour systolic blood pressure was 126 ± 11mmHg, ECV fraction was 25.0 ± 2.0% and 27% of participants met CMR criteria of LV hypertrophy. After 12 months, a modest but significant reduction in ECV fraction was observed in patients treated with MAD (24.9 ± 2.3% to 24.0 ± 2.2%; P = 0.047) and CPAP (25.1 ± 1.9% to 24.4 ± 1.6%; P = 0.004). There was no significant difference in ECV fraction reduction between MAD and CPAP (P = 0.576). No significant between-group differences were observed for changes in LV mass, cardiac volumes and function. Both MAD and CPAP were associated with modest reductions in ECV fraction over 12 months, with no detectable between-group difference. No accompanying improvements in LV mass or cardiac function were observed, likely reflecting the predominantly preserved myocardial phenotype at baseline. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling—Non-inferiority Trial [CRESCENT]; NCT04119999).
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1038/s41598-026-67940-w.
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BibTeX
@article{iyer2026effects,
title = {{Effects of mandibular advancement device versus continuous positive airway pressure on cardiac remodeling in obstructive sleep apnea: a randomized CMR substudy}},
author = {Nithin R. Iyer and Yi-Hui Ou and Jennifer A. Bryant and Thu-Thao Le and Juliana Tereza Colpani and Crystal S. Cheong and Weiqiang Loke and Peter A. Cistulli and Martin Ugander and Chi-Hang Lee and Calvin W. L. Chin},
journal = {Scientific Reports},
year = {2026},
month = aug,
doi = {10.1038/s41598-026-67940-w},
url = {https://doi.org/10.1038/s41598-026-67940-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Effects of mandibular advancement device versus continuous positive airway pressure on cardiac remodeling in obstructive sleep apnea: a randomized CMR substudy
AU - Nithin R. Iyer
AU - Yi-Hui Ou
AU - Jennifer A. Bryant
AU - Thu-Thao Le
AU - Juliana Tereza Colpani
AU - Crystal S. Cheong
AU - Weiqiang Loke
AU - Peter A. Cistulli
AU - Martin Ugander
AU - Chi-Hang Lee
AU - Calvin W. L. Chin
PY - 2026
DA - 2026/08/24
JO - Scientific Reports
DO - 10.1038/s41598-026-67940-w
UR - https://doi.org/10.1038/s41598-026-67940-w
AB - Obstructive sleep apnea (OSA) is associated with adverse cardiac remodeling, including diffuse myocardial fibrosis. Continuous positive airway pressure (CPAP) is the standard treatment for OSA, while mandibular advancement devices (MAD) may represent an alternative. However, their comparative effects on myocardial structure remain incompletely defined. To compare the effects of MAD and CPAP on cardiac remodeling assessed by cardiovascular magnetic resonance (CMR) in patients with OSA. This prespecified CMR substudy of the randomized CRESCENT trial included patients who agreed to participate in both baseline and 12-month CMR examinations (aged 59±8 years, 89% male, with hypertension, elevated cardiovascular risk and moderate-to-severe OSA). The mean body mass index was 28.6±4.6 kg/m2. Participants underwent contrast-enhanced CMR at baseline and after 12 months of treatment with either MAD (n = 36) or CPAP (n = 49). CMR-derived measures included left ventricular (LV) mass, cardiac volumes and function; and extracellular volume (ECV) fraction as a marker of diffuse myocardial fibrosis. At baseline, mean 24-hour systolic blood pressure was 126 ± 11mmHg, ECV fraction was 25.0 ± 2.0% and 27% of participants met CMR criteria of LV hypertrophy. After 12 months, a modest but significant reduction in ECV fraction was observed in patients treated with MAD (24.9 ± 2.3% to 24.0 ± 2.2%; P = 0.047) and CPAP (25.1 ± 1.9% to 24.4 ± 1.6%; P = 0.004). There was no significant difference in ECV fraction reduction between MAD and CPAP (P = 0.576). No significant between-group differences were observed for changes in LV mass, cardiac volumes and function. Both MAD and CPAP were associated with modest reductions in ECV fraction over 12 months, with no detectable between-group difference. No accompanying improvements in LV mass or cardiac function were observed, likely reflecting the predominantly preserved myocardial phenotype at baseline. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling—Non-inferiority Trial [CRESCENT]; NCT04119999). Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1038/s41598-026-67940-w.
SN - 2045-2322
ER -