Inflammatory Cytokine Level in Patients with Obstructive Sleep Apnea and Treatment Outcome of Oral Appliance Therapy

Abstract

Purpose:The aims of this study were to analyze the association between inflammatory cytokine and obstructive sleep apnea (OSA), and to evaluate treatment outcome and changes of plasma inflammatory cytokine levels after oral appliance therapy.Methods: Twenty-seven subjects who visited Department of Oral Medicine in Seoul National University Dental Hospital were performed nocturnal polysomnography and analyzed plasma C-reactive protein (CRP), interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor (TNF)-α levels. Each subject was evaluated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The subjects were classified into 12 OSA patients (apnea-hypopnea index [AHI] >5) and 15 control (AHI ≤5) groups. The OSA group was treated with mandibular advancement device (MAD) for 3 months and re-evaluated nocturnal polysomnography and plasma inflammatory cytokine levels.Results: Plasma TNF-α, IL-10, and IL-6 levels were significantly higher in OSA patients compared to controls. Total AHI showed significant positive correlations with plasma IL-6 and TNF-α levels. Percentage time of SpO 2 <90 and lowest SpO 2 were significantly correlated with plasma TNF-α level. ESS showed significant positive correlation with plasma IL-10 level. Total AHI, percentage time of SpO 2 <90, lowest SpO 2 , and mean SpO 2 were significantly improved after the MAD therapy. Plasma TNF-α level was significantly decreased after MAD therapy. Conclusions:We suggest that MAD therapy is an effective treatment modality for patients with OSA and can decrease plasma cytokine level.

Associations between obstructive sleep apnea and painful temporomandibular disorder: a systematic review

“…The influence of OSA management on pain outcome has been proposed in previous reports. The delivery of continuous positive airway pressure (CPAP) may improve pain intensity and tolerance 44 - 46 , and the use of oral appliance can lessen the systemic inflammatory cytokine levels in patients with TMD 47 . However, the use of CPAP and oral appliance to manage OSA in patients with painful TMD should be carefully considered as both may cause mask discomfort and orofacial pain at the initial stage of the therapy 48 , 49 .…”