Effects of mandibular advancement device treatment on arterial stiffness and glucose metabolism in patients with mild to moderate obstructive sleep apnea: a prospective 1 year study.
OBJECTIVE
An independent association between obstructive sleep apnea (OSA) and cardiovascular events has been reported, suggesting that OSA may lead to cardiometabolic dysregulation. We prospectively investigated the effect of mandibular advancement device (MAD) treatment on arterial stiffness, glucose metabolism, and certain inflammatory markers as predictors of cardiometabolic risk in mild to moderate OSA patients.


METHODS
A total of 18 patients with mild to moderate OSA were prospectively enrolled in the study to determine the effects of MAD treatment at 3 months and 1 year following initiation of the treatment. Sleep studies, arterial stiffness assessment, and laboratory analyses were obtained at the baseline and at the time of follow-up. The data collected at 1 year were compared to baseline values.


RESULTS
There was a significant decrease in apnea-hypopnea index (AHI) after 1 year of treatment when compared to baseline (22.9 ± 5.9 to 9.7 ± 4.5, P < 0.001). Furthermore, MAD treatment was associated with reduced levels of fasting plasma glucose values after 1 year of treatment (5.3 ± 0.5 to 4.9 ± 0.5 mmol/L, P < 0.001), as well as fasting plasma insulin values (14.1 ± 7.8 to 10.9 ± 6.4 μU/mL, P < 0.05) and HOMA-IR (3.3 ± 1.8 to 2.4 ± 1.4, P < 0.001). There was significant improvement in pulse wave velocity (9.3 ± 1.9 m/s at baseline to 8.1 ± 1.7 m/s, P < 0.05) after 1 year of treatment. Plasma level of an inflammatory marker fibrinogen decreased significantly from 3.4 ± 0.7 at baseline to 3.0 ± 0.9, (P < 0.05) at 1-year follow-up.


CONCLUSIONS
The MAD treatment improved arterial stiffness, glucose metabolism, and insulin resistance in mild to moderate OSA patients after 1 year of treatment.
Study of Dental Medicine, University of Split School of Medicine, Soltanska 2, Split, Croatia.
Tea
T
Galic
Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia.
Josko
J
Bozic
Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia.
Natalija
N
Ivkovic
Department of Pharmacology, University of Split School of Medicine, Soltanska 2, Split, Croatia.
Grgo
G
Gunjaca
Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, Split, Croatia.
Tina Kurir
TK
Ticinovic
Split Sleep Medicine Center, University of Split School of Medicine, Soltanska 2, Split, Croatia. zdogas@mefst.hr.|Department of Neuroscience, University of Split School of Medicine, Soltanska 2, 21000, Split, Croatia. zdogas@mefst.hr.
Zoran
Z
Dogas
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D017286:Polysomnography; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D059289:Vascular Stiffness / Q000502:physiology*
D001786:Blood Glucose; D018836:Inflammation Mediators; D005340:Fibrinogen
Arterial stiffness; Cardiovascular risk; Glucose metabolism; Mandibular advancement device; Obstructive sleep apnea