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Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review

Sleep and Breathing volume 26, pages 1447–1458 (2022)Cite this article

Abstract

Purpose

This review aimed to evaluate the effects of oral appliance (OA) therapy on serum inflammatory cytokines in adults diagnosed with obstructive sleep apnea (OSA).

Methods

Seven electronic databases and partial gray literature were searched without restrictions through March 2021. Articles evaluating the levels of serum inflammatory cytokines in patients with OSA after OA treatment were included. The risk of bias (RoB) was assessed using the before-and-after tool or RoB 2.0. The level of certainty was assessed using the GRADE tool.

Results

Five studies met the eligibility criteria. One was a randomized clinical trial (RCT), while four were non-randomized clinical trials (NRCTs). Among the studies, C-reactive protein (CRP), IL-6, IL-10, IL-1β, and tumor necrosis factor α (TNF-α) were investigated. The RCT reported no significant differences in marker levels after 2 months of OA therapy, while the NRCTs showed improvement on CRP, TNF-α, and IL-1β levels after longer follow-up periods. The RoB was evaluated as showing some concern in the RCT. Three NRCTs presented good RoB, and one showed a fair RoB. The level of certainty was graded as moderate quality for inflammatory marker levels assessed in the RCT The levels of certainty evaluated in NRCTs were classified as very low.

Conclusions

Although limited, existing scientific evidence showed that OA therapy may improve serum cytokine levels in adults with OSA. However, short treatment periods are not effective in reducing markers of systemic inflammation which may require extended time and a decrease of in apneic events to improve.

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Availability of data and material

The data used to support the conclusion of this review is available in the article.

Code availability

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Authors and Affiliations

  1. Department of Orthodontics, Faculdade Integrada Brasil Amazônia (FIBRA), Belém, Pará, Brazil

    Paulo Mecenas

  2. Faculty of Dentistry, Faculdade Integrada Brasil Amazônia (FIBRA), Belém, Pará, Brazil

    Giza Hellen Nonato Miranda

  3. School of Dentistry, University of Alberta, Edmonton, AB, Canada

    Nathalia Carolina Fernandes Fagundes

  4. Faculty of Dentistry, Federal University of Pará (UFPA), Belém, Pará, Brazil

    David Normando

  5. Department of Orthodontics, Brazilian Dental Association, Belém, Brazil

    Karina Correa Flexa Ribeiro

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Concept and design, NKFF and KCFR; literature search, PM and GHNM; data extraction and analysis, PM and GHNM; drafting of the manuscript, PM and GHNM; critical revision of the manuscript, DN. All authors approved the version to be published. All authors assume responsibility for the content of the work.

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Correspondence to Paulo Mecenas.

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Mecenas, P., Miranda, G.H.N., Fagundes, N.C.F. et al. Effects of oral appliances on serum cytokines in adults with obstructive sleep apnea: a systematic review. Sleep Breath 26, 1447–1458 (2022). https://doi.org/10.1007/s11325-021-02485-y

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