CPAP vs. Oral Appliances: How Do They Impact Heart Health and Sleep Quality?

Written By Nick Koogler

When it comes to treating obstructive sleep apnea (OSA), many patients are familiar with CPAP machines and oral appliances. But which therapy does more than just help you sleep — and can either improve your heart health?

A new study looked into both arterial stiffness (a predictor of heart disease) and quality of life (QoL) in patients using CPAP or Mandibular Advancement Appliances (MAA). The results? Oral appliances may offer greater day-to-day symptom relief, but neither therapy showed clear cardiovascular benefits — at least not in the short term.

What Is Arterial Stiffness — and Why Does It Matter?

Arterial stiffness refers to how flexible your blood vessels are. When arteries become stiff:

  • Blood pressure increases

  • Heart disease risk goes up

  • Oxygen delivery to tissues decreases

Researchers used pulse wave velocity (PWV) to measure arterial stiffness, a common non-invasive test.

Study Setup

This cross-sectional study included 105 patients over age 50 with moderate to severe OSA, divided into:

  • A CPAP treatment group

  • An oral appliance (MAA) group

  • An untreated control group

All treatments had been in place for at least 6 months. Researchers measured:

  • Arterial stiffness via the Mobil-O-Graph device

  • Blood pressure, heart rate, and pulse wave velocity

  • Sleep quality and daytime symptoms using the Quebec Sleep Questionnaire (QSQ)

What They Found

Quality of Life (QoL)

  • Both CPAP and MAA users felt better than untreated patients

  • MAA users had higher scores across all QoL domains — especially less daytime sleepiness

  • CPAP users showed improvement mainly in nighttime symptoms, like snoring and dry mouth

  • MAA outperformed CPAP in daytime alertness and overall symptom relief

Arterial Stiffness

  • No significant improvement in arterial stiffness in any group

  • Blood pressure, heart rate, and vascular measurements remained the same across all treatments

  • MAA and CPAP groups did show a trend toward better values, but not statistically significant

What Does This Mean?

  • CPAP and oral appliances both help reduce OSA symptoms

  • MAAs may improve quality of life more, especially for people bothered by daytime fatigue

  • However, cardiovascular benefits were not detected in this 6-month snapshot

  • Longer studies may be needed to understand if these treatments help prevent heart disease

Even if your OSA treatment helps you sleep better, it might not immediately improve heart-related markers like arterial stiffness.

Should I Choose CPAP or an Oral Appliance?

CPAP is still the gold standard, especially for severe OSA or those with high cardiovascular risk. But:

  • Oral appliances are more comfortable and easier to use

  • Patients often stick with MAAs longer than with CPAP

  • For those who can’t tolerate CPAP, oral appliances are a clinically validated option

If your main goal is better daily energy, mood, and sleep quality, oral appliances may be the right choice.

TL;DR

  • CPAP and oral appliances improve sleep quality and reduce symptoms

  • Oral appliances (MAAs) lead to better scores in quality of life — especially for daytime sleepiness

  • No short-term change in arterial stiffness was found in either treatment

  • More long-term studies are needed to know if OSA therapy can improve cardiovascular health

Source:
 de Andrade JGT, et al. Evaluation of Arterial Stiffness and Quality of Life in the Treatment of Moderate to Severe OSA with CPAP or Mandibular Advancement Appliance: A Cross-Sectional Study. BMC Cardiovascular Disorders. 2024; 24:657.
https://doi.org/10.1186/s12872-024-04344-6

Nick Koogler
Next

CPAP Not Working for You? Oral Appliances Are Effective Long-Term, Study Finds