Both continuous positive airway pressure and mandibular advancement devices for the treatment of obstructive sleep apnea were associated with similar reductions in systolic and diastolic blood pressure, according to research published in JAMA.

Malcolm Kohler, MD, of University Hospital Zurich in Zurich, Switzerland, and colleagues conducted a meta-analysis comparing the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), or an inactive control (e.g., placebo or no treatment) with changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with obstructive sleep apnea.

Of the 51 studies (4888 participants) that met criteria for the meta-analysis, 44 compared CPAP with an inactive control (4289 participants), 3 compared MADs with an inactive control (229 participants), 1 compared CPAP with MADs (126 patients), and 3 compared CPAP, MADs, and an inactive control (244 patients).

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The researchers found that compared with inactive controls, CPAP was associated with a reduction in SBP of 2.5 mm Hg and in DBP of 2.0 mm Hg, and that a 1 hour-per-night average increase in the use of CPAP was associated with an additional reduction in SBP of 1.5 mm Hg and DBP of 0.9 mm Hg. MADs were associated with a reduction in SBP of 2.1 mm Hg and in DBP of 1.9 mm Hg.

The authors note that while there was no statistically significant difference between the use of CPAP and MADs and changes in blood pressure, CPAP had a much higher probability of being the most strongly associated with SBP reduction.

“The associations of both CPAP and MADs with DBP reduction were more similar; however, the association of CPAP with reductions of both SBP and DBP is likely to be greater in patients using CPAP for longer periods at night or in those with higher baseline BP levels,” the authors wrote.


  1. Bratton DJ, Gaisl T, Wons AM, Kohler M. CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. JAMA. 2015; doi:10.1001/jama.2015.16303.