Evidence in Reaching Consensus in Usage of Mandibular Advancement Device for Pre- and Post-obstructive Sleep Apnea Treatment with Blood and Salivary Inflammatory Biomarkers Profiles

To date, inconsistencies in biological sample-based biomarkers and processing protocols exist for determining obstructive sleep apnea (OSA), characterized by recurrent upper airway collapse. Hence, in this study, we investigated blood and salivary inflammatory biomarker profiles in pre- and post-MAD treated OSA patients.

We corroborated OSA characteristics in 12 patients through polysomnography, which were treated with customized titratable MAD. Saliva and blood samples were obtained to determine inflammatory and stressed states through salivary α-amylase and cortisol. serum levels of CRP, IL-6, and TNF-α were also measured.

Levels of salivary alpha-amylase (12.86 ± 7.81 to 10.73 ± 6.60) p = 0.001 were significantly reduced with no significant difference between cortisol levels in the morning (19.79 ± 15.67 to 21.09 ± 17.97, p = 0.647), afternoon (26.73 ± 38.50 to 22.47 ± 19.36, p = 0.566), and evening (10.51 ± 7.86 to 8.02 ± 6.14, p = 0.054). Additionally, CRP (2.65 ± 0.88 to 2.19 ± 0.60) p = 0.010, IL-6 (3.12 ± 1.92 to 2.61 ± 1.50) p = 0.009, and TNF-α (40.43 ± 98.84 to 38.18 ± 100.82) p = 0.026 were significantly suppressed.

MAD exerted anti-inflammatory, anti-stress & depression-exerting impacts in OSA patients, possibly via hypothalamic–pituitary–adrenal (HPA) axis. In our opinion, MAD is an economical alternative compared to positive airway pressure (PAP) in mild-moderate OSA, while in severe cases, a synergistic approach of MAD and PAP may be considered.