Impact of Mandibular Advancement Devices on CRP Levels in Patients with Obstructive Sleep Apnea

Abstract

Objectives:

Determine the effect non-surgical treatment of obstructive sleep apnea/hypopnea syndrome (OSAHS) using an oral appliance has on C-reactive protein (CRP) levels. Design: Retrospective case study.

Methods:

Patients with OSAHS, confirmed by apnea-hypopnea index (AHI), and fitted with a custom oral appliance between December 2011 and November 2012 were reviewed. The non-specific inflammatory marker CRP was determined prior to oral appliance fitting and after improvement of OSAHS symptoms determined by AHI.

Results:

Fifty consecutive patients (78.0% male, age 47.7±11.8 years, body mass index 29.5±5.1 kg/m²) were treated for moderate/severe OSAHS using a fitted oral appliance (mean initial AHI 33.3±21.7, mean initial oxygen saturation 85.2±5.9). Oral appliance treatment significantly improved patients’ AHI, reducing AHI by an average of 40.5% (follow-up mean 11.9±22.1, p<0.001) as well as increasing average oxygen saturation (follow-up mean 90.6±3.6). These patients initially had a relative elevation in CRP (mean initial CRP 2.5±1.8 mg/dL) that decreased following use of their fitted oral appliance, a significant reduction to an average of 1.9±1.3 mg/dL (p = 0.006).

Conclusions:

Elevated CRP levels, notably shown to be associated with increased risk of cardiovascular disease, were significantly decrease with oral appliance therapy. Oral appliance therapy achieves reasonable response and cure rates in patients with moderate/severe OSAHS, and as demonstrated by the case review, has the added benefit of reducing the risk cardiovascular events.