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TREATMENT WITH MANDIBULAR ADVANCEMENT DEVICES IN COMORBID INSOMNIA AND SLEEP APNEA

By Lílian Chrystiane Giannasi, D Gozal, Luís Vicente Franco Vilela, Marco Antônio Cardoso Machado, Mônica Fernandes Gomes
Hypothesis
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Editor's note
Treating sleep apnea can measurably reduce the allostatic load it creates—this work shows mandibular devices not only improve breathing metrics but restore autonomic balance, measured through heart rate variability, which tracks the nervous system's capacity to recover. This finding is incremental within sleep medicine but clinically important: it demonstrates that mechanical airway interventions address the physiologic stress cascade, not just obstruction. Pulmonologists, sleep specialists, and cardiologists managing patients with comorbid sleep disorders should recognize this autonomic recovery pathway.

Source: openalex · Origin: BR · Lílian Chrystiane Giannasi, D Gozal, Luís Vicente Franco Vilela, Marco Antônio Cardoso Machado, Mônica Fernandes Gomes · InterAmerican Journal of Medicine and Health · 2026-05-25

URL: https://doi.org/10.31005/iajmh.v8i.317

AI rationale (4/5, tier: emerging): HRV biomarker outcome in sleep-apnea intervention; autonomic modulation relevant to allostatic load, though not core HPA-axis focus.

Introduction: Comorbid insomnia and sleep apnea (COMISA) is a prevalent and clinically significant condition associated with increased cardiometabolic risk. This study aimed to evaluate treatment with mandibular advancement oral appliances (OAm) in COMISA patients by assessing its impact on sleep-disordered breathing, insomnia severity, and autonomic nervous system modulation. Methods: A retrospective multicentric case-control study was conducted, comprising two cohorts. Cohort 1 included patients diagnosed with OSA (n=35) or COMISA (n=31) who underwent OAm therapy. Cohort 2 consisted of 12 COMISA patients treated with a titratable OAm. Clinical, polysomnographic, and heart rate variability (HRV) measures were assessed pre- and post-treatment. HRV analyses were conducted using time-domain and frequency-domain parameters, including fast Fourier transform and wavelet spectral methods. Results: In Cohort 1, post-treatment apnea-hypopnea index (AHI) improved significantly in both OSA and COMISA groups, but COMISA patients retained a slightly elevated residual AHI (6.4±6.9 vs. 3.7±3.2 events/hour; p=0.04). Sleep latency in COMISA patients decreased significantly from 63.6±46.0 min to 22.8±20.8 min (p=0.001). In Cohort 2, AHI decreased from 22.7±12.7 to 4.0±3.5 events/hour (p

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Published 2026-05-26 · Last kit-update 2026-05-26