Effect of mandibular advancement therapy on inflammatory biomarkers in obstructive sleep apnea: A systematic review

To review the literature on the effect of mandibular advancement therapy (MAT) on inflammatory biomarkers in obstructive sleep apnea (OSA). The present systematic review addresses the following focus question: What is the effect of MAT on inflammatory biomarkers in OSA? Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published until September 2021 to collect information about the effect of mandibular advancement therapy, a non-continuous positive airway pressure alternative measurement of OSA. A systematic literature review was performed following the PRISMA guidelines to identify studies evaluating the effect of MAT in patients suffering from OSA. Randomized clinical trials were included, and case reports, retrospective studies, literature reviews, in-vitro studies, observational studies, authors' opinions, letters to the editor, and engineering articles were excluded. Fifty-nine articles published before September 2021 were identified. Fifty-four articles met the inclusion criteria. After assessing inclusion criteria, three clinical trials were included with 148 patients suffering from OSA and treated with mandibular advancement therapy. The follow-up period ranged from two to three months, with the average follow-up being 1.66 months. The mean age of the patients was observed to be 53.11 ± 2.65 years. The mean Epworth Sleepiness Scale observed in patients in all three clinical trials was 9.75 ± 0.89. MAT in patients with moderate or severe OSA reduced apnea-hypopnea index but has less effect on inflammatory and metabolic biomarkers.