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Volume 10 No. 03
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Accepted Papers

Scientific Investigations

Modulation of Inflammatory and Hemostatic Markers in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Splints: A Parallel, Controlled Trial

Agata Niżankowska-Jędrzejczyk, D.D.S., Ph.D.1; Fernanda R. Almeida, D.D.S., Ph.D.2; Alan A. Lowe, D.M.D., Ph.D.2; Aleksander Kania, M.D., Ph.D.3; Paweł Nastałek, M.D.3; Filip Mejza, M.D., Ph.D.3; Jonathan H. Foley, Ph.D.4; Ewa Niżankowska-Mogilnicka, M.D., Ph.D.3; Anetta Undas, M.D., Ph.D.5
1Department of Orthodontics, Jagiellonian University Medical College, Krakow, Poland; 2Department of Oral Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada; 3Department of Pulmonology, Jagiellonian University Medical College, Krakow, Poland; 4Department of Biochemistry, University of Vermont, Burlington, VT; 5Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland

Study Objective:

Obstructive sleep apnea (OSA) is associated with systemic inflammation and a hypercoagulable state. The current study aim was to investigate whether mandibular advancement splint (MAS) therapy affects inflammatory and hemostatic parameters in patients with mild-to-moderate OSA.


Twenty-two patients with mild-to-moderate OSA and 16 control subjects were studied. OSA subjects were treated with a titratable MAS for 6 months. Baseline plasma C-reactive protein, interleukin-1β, interleukin-10, interleukin-6, P-selectin, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1), thrombin-antithrombin complex, activated thrombin-activatable fibrinolysis inhibitor (TAFIa), 6-keto-PGF1α, glucose, and fibrin clot lysis time (CLT) were measured in all subjects. After 3 months of MAS therapy, measurements were repeated for the 22 patients, and after 6 months all measurements were repeated for all study subjects.


MAS treatment reduced significantly AHI at 3 months (24 vs 13.1/h) and further improved it at 6 months (13.1 vs 7.05/h). Compared with controls, OSA subjects had a significant higher baseline mean levels of fibrinogen, TAFIa, 6-keto-PGF1α, and glucose. MAS treatment significantly improved levels of IL-1β, D-dimer, TAFIa, and CLT. Despite residual apneas, MAS treatment group presented similar measured homeostatic and inflammatory levels to controls except for glucose.


Treatment with MAS in mild-to-moderate OSA subjects improves the inflammatory profile and homeostatic markers.


Niżankowska-Jędrzejczyk A; Almeida FR; Lowe AA; Kania A; Nastałek P; Mejza F; Foley JH; Niżankowska-Mogilnicka E; Undas A. Modulation of inflammatory and hemostatic markers in obstructive sleep apnea patients treated with mandibular advancement splints: a parallel, controlled trial. J Clin Sleep Med 2014;10(3):255-262.

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