Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea.

BACKGROUND: Hypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for patients who decline or cannot tolerate continuous positive airway pressure (CPAP). OBJECTIVES: We compared the relative effectiveness of MAD vs CPAP in reducing 24-hour ambulatory blood pressure (BP). METHODS: In an investigator-initiated, randomized, noninferiority trial (prespecified margin 1.5 mm Hg), 321 participants aged ≥40 years with hypertension and increased cardiovascular risk were recruited at 3 public hospitals for polysomnography. Of these, 220 participants with moderate-to-severe OSA (apnea-hypopnea index ≥15 events per hour) were randomized to either MAD or CPAP (1:1). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and 6 months. RESULTS: Compared with baseline, the 24-hour mean arterial BP decreased by 2.5 mm Hg (P = 0.003) at 6 months in the MAD group, whereas no change was observed in the CPAP group (P = 0.374). The between-group difference was -1.6 mm Hg (95% CI: -3.51 to 0.24, noninferiority P < 0.001). The MAD group demonstrated a larger between-group reduction in all secondary ambulatory BP parameters compared with the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with the between-group difference similar (P = 0.384). There were no between-group differences in cardiovascular biomarkers. CONCLUSIONS: MAD is noninferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling-Non-inferiority Trial [CRESCENT]; NCT04119999).

Relação diagnóstica entre folículo pericoronário e cisto dentígero / Diagnostic relationship between pericoronal follicle and dentigerous cyst

Objetivo: Relacionar os diagnósticos histopatológico e radiográfico para casos de folículo pericoronário e cisto dentígero de terceiros molares inferiores. Métodos: Foram selecionadas, em arquivos, as lâminas histológicas e as respectivas radiografias panorâmicas dos casos diagnosticados como folículo pericoronário e cisto dentígero. Obteve-se uma amostra de 62 casos elegíveis: 45 folículos pericoronários e 17 cistos dentígeros. Para confirmação do diagnóstico histopatológico foram reavaliadas as informações clínicas dos pacientes e as lâminas histológicas. No exame radiográfico foi realizada a mensuração das imagens radiolúcidas pericoronárias, sendo que medidas iguais ou maiores do que 2,5mm foram utilizadas como parâmetro para o diagnóstico de cistos dentígeros. A comparação entre os resultados dos diagnósticos histopatológico e radiográfico, atribuídos aos 62 casos apurados, foi feita pelos testes de sensibilidade, especificidade e valor preditivo. Resultados: Os resultados mostraram que a medida de 2,5mm para o halo radiolúcido pericoronário foi pouco sensível no diagnóstico de cisto dentígero. Conclusão: O diagnóstico diferencial das imagens radiolúcidas pericoronárias deve ser esclarecido pela soma de dados clínicos, radiográficos e histopatológicos.

Objective: Associate the histopathological and radiographic diagnoses of cases of pericoronal follicle and dentigerous cyst of the mandibular third molars. Methods: Histological slides and the respective panoramic radiographs of cases diagnosed as pericoronal follicle and dentigerous cyst were selected from files. A sample of 62 eligible cases was obtained: 45 pericoronal follicles and 17 dentigerous cysts. In order to confirm the histopathological diagnosis, the clinical information and histological slides of the patients were reassessed. The pericoronal radiolucent images in the radiographs were measured and those equal to or greater than 2.5 mm were used as parameter for the diagnosis of dentigerous cysts. The comparison between the results of the histopathological and radiographic diagnoses attributed to the 62 cases was done by sensitivity and specificity tests and by predictive value. Results: The results showed that a size of 2.5 mm for the pericoronal radiolucent halo was not very sensitive for the diagnosis of dentigerous cyst. Conclusion: The differential diagnosis of the pericoronal radiolucent images must be clarified by the sum of clinical, histopathological and radiographic data.