title: Modulation of inflammatory and hemostatic markers in obstructive sleep apnea patients treated with mandibular advancement splints: a parallel, controlled trial.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Treatment with MAS in mild-to-moderate OSA subjects improves the inflammatory profile and homeostatic markers.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Orthodontics, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Niżankowska-Jędrzejczyk
authors.affiliation: Department of Oral Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Fernanda R
authors.initials: FR
authors.lastname: Almeida
authors.affiliation: Department of Oral Health Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Lowe
authors.affiliation: Department of Pulmonology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kania
authors.affiliation: Department of Pulmonology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Nastałek
authors.affiliation: Department of Pulmonology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Filip
authors.initials: F
authors.lastname: Mejza
authors.affiliation: Department of Biochemistry, University of Vermont, Burlington, VT.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Foley
authors.affiliation: Department of Pulmonology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Niżankowska-Mogilnicka
authors.affiliation: Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Anetta
authors.initials: A
authors.lastname: Undas
mesh_terms: D015121:6-Ketoprostaglandin F1 alpha / Q000097:blood; D000990:Antithrombin III; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D025901:Carboxypeptidase B2 / Q000097:blood; D016022:Case-Control Studies; D063285:Fibrin Clot Lysis Time; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D019007:P-Selectin / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000097:blood / Q000503:physiopathology / Q000628:therapy*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D005338:Fibrin Fibrinogen Degradation Products; D053583:Interleukin-1beta; D015850:Interleukin-6; D019007:P-Selectin; D017395:Plasminogen Activator Inhibitor 1; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D016753:Interleukin-10; D015121:6-Ketoprostaglandin F1 alpha; D000990:Antithrombin III; D005340:Fibrinogen; D002097:C-Reactive Protein; D010447:Peptide Hydrolases; D025901:Carboxypeptidase B2
keywords: Obstructive sleep apnea; TAFIa; fibrinolysis; homeostatic markers; inflammatory markers; interleukin-10; mandibular advancement splint; oral appliance; sleep apnea; snoring