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 Mar 15;10(3):255-62. doi: 10.5664/jcsm.3522.


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.

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.

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

Citation: 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.

Keywords: Obstructive sleep apnea; TAFIa; fibrinolysis; homeostatic markers; inflammatory markers; interleukin-10; mandibular advancement splint; oral appliance; sleep apnea; snoring.

Publication types

  • Controlled Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 6-Ketoprostaglandin F1 alpha / blood
  • Antithrombin III
  • Biomarkers / blood
  • Blood Glucose / analysis
  • C-Reactive Protein / analysis
  • Carboxypeptidase B2 / blood
  • Case-Control Studies
  • Fibrin Clot Lysis Time
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinogen / analysis
  • Humans
  • Interleukin-10 / blood
  • Interleukin-1beta / blood
  • Interleukin-6 / blood
  • Male
  • Mandibular Advancement*
  • Middle Aged
  • P-Selectin / blood
  • Peptide Hydrolases / blood
  • Plasminogen Activator Inhibitor 1 / blood
  • Polysomnography
  • Sleep Apnea, Obstructive / blood
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Apnea, Obstructive / therapy*


  • Biomarkers
  • Blood Glucose
  • Fibrin Fibrinogen Degradation Products
  • Interleukin-1beta
  • Interleukin-6
  • P-Selectin
  • Plasminogen Activator Inhibitor 1
  • antithrombin III-protease complex
  • fibrin fragment D
  • Interleukin-10
  • 6-Ketoprostaglandin F1 alpha
  • Antithrombin III
  • Fibrinogen
  • C-Reactive Protein
  • Peptide Hydrolases
  • Carboxypeptidase B2