DOI QR코드

DOI QR Code

Inflammatory Cytokine Level in Patients with Obstructive Sleep Apnea and Treatment Outcome of Oral Appliance Therapy

  • Oh, Jae-Tak (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University) ;
  • Chung, Jin-Woo (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University)
  • 투고 : 2016.07.26
  • 심사 : 2016.08.02
  • 발행 : 2016.09.30

초록

Purpose: The aims of this study were to analyze the association between inflammatory cytokine and obstructive sleep apnea (OSA), and to evaluate treatment outcome and changes of plasma inflammatory cytokine levels after oral appliance therapy. Methods: Twenty-seven subjects who visited Department of Oral Medicine in Seoul National University Dental Hospital were performed nocturnal polysomnography and analyzed plasma C-reactive protein (CRP), interleukin (IL)-$1{\beta}$, IL-6, IL-10, and tumor necrosis factor (TNF)-${\alpha}$ levels. Each subject was evaluated with Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The subjects were classified into 12 OSA patients (apnea-hypopnea index [AHI] >5) and 15 control (AHI ${\leq}5$) groups. The OSA group was treated with mandibular advancement device (MAD) for 3 months and re-evaluated nocturnal polysomnography and plasma inflammatory cytokine levels. Results: Plasma TNF-${\alpha}$, IL-10, and IL-6 levels were significantly higher in OSA patients compared to controls. Total AHI showed significant positive correlations with plasma IL-6 and TNF-${\alpha}$ levels. Percentage time of $SpO_2$ <90 and lowest $SpO_2$ were significantly correlated with plasma TNF-${\alpha}$ level. ESS showed significant positive correlation with plasma IL-10 level. Total AHI, percentage time of $SpO_2$ <90, lowest $SpO_2$, and mean $SpO_2$ were significantly improved after the MAD therapy. Plasma TNF-${\alpha}$ level was significantly decreased after MAD therapy. Conclusions: We suggest that MAD therapy is an effective treatment modality for patients with OSA and can decrease plasma cytokine level.

키워드

참고문헌

  1. Kapsimalis F, Richardson G, Opp MR, Kryger M. Cytokines and normal sleep. Curr Opin Pulm Med 2005;11:481-484. https://doi.org/10.1097/01.mcp.0000183062.98665.6b
  2. Krueger MH, Roth T, Dement WC. Principles and practice of sleep medicine. 4th ed. Philadelphia: Elsevier; 2005.
  3. Krueger JM, Majde JA. Humoral links between sleep and the immune system: research issues. Ann N Y Acad Sci 2003;992:9-20. https://doi.org/10.1111/j.1749-6632.2003.tb03133.x
  4. Opp MR, Toth LA. Neural-immune interactions in the regulation of sleep. Front Biosci 2003;8:d768-d779. https://doi.org/10.2741/1061
  5. Koskenvuo M, Kaprio J, Partinen M, Langinvainio H, Sarna S, Heikkila K. Snoring as a risk factor for hypertension and angina pectoris. Lancet 1985;1:893-896.
  6. Norton PG, Dunn EV. Snoring as a risk factor for disease: an epidemiological survey. Br Med J (Clin Res Ed) 1985;291:630-632. https://doi.org/10.1136/bmj.291.6496.630
  7. Koskenvuo M, Kaprio J, Telakivi T, Partinen M, Heikkila K, Sarna S. Snoring as a risk factor for ischaemic heart disease and stroke in men. Br Med J (Clin Res Ed) 1987;294:16-19. https://doi.org/10.1136/bmj.294.6563.16
  8. Yamagishi K, Ohira T, Nakano H, et al. Cross-cultural comparison of the sleep-disordered breathing prevalence among Americans and Japanese. Eur Respir J 2010;36:379-384. https://doi.org/10.1183/09031936.00118609
  9. Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc 2008;5:242-252. https://doi.org/10.1513/pats.200708-135MG
  10. Bixler EO, Vgontzas AN, Lin HM, et al. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep 2009;32:731-736. https://doi.org/10.1093/sleep/32.6.731
  11. Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 2005;112:2660-2667. https://doi.org/10.1161/CIRCULATIONAHA.105.556746
  12. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021. https://doi.org/10.1001/jama.284.23.3015
  13. Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K, Chrousos GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab 1997;82:1313-1316. https://doi.org/10.1210/jcem.82.5.3950
  14. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002;105:2462-2464. https://doi.org/10.1161/01.CIR.0000018948.95175.03
  15. Yokoe T, Minoguchi K, Matsuo H, et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003;107:1129-1134. https://doi.org/10.1161/01.CIR.0000052627.99976.18
  16. Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep 2007;30:29-34. https://doi.org/10.1093/sleep/30.1.29
  17. Sharma SK, Mishra HK, Sharma H, et al. Obesity, and not obstructive sleep apnea, is responsible for increased serum hs-CRP levels in patients with sleep-disordered breathing in Delhi. Sleep Med 2008;9:149-156. https://doi.org/10.1016/j.sleep.2007.02.004
  18. Ryan S, Nolan GM, Hannigan E, Cunningham S, Taylor C, Mc-Nicholas WT. Cardiovascular risk markers in obstructive sleep apnoea syndrome and correlation with obesity. Thorax 2007;62:509-514. https://doi.org/10.1136/thx.2006.066720
  19. Chin K, Ohi M, Kita H, et al. Effects of NCPAP therapy on fibrinogen levels in obstructive sleep apnea syndrome. Am J Respir Crit Care Med 1996;153:1972-1976. https://doi.org/10.1164/ajrccm.153.6.8665063
  20. Sahlman J, Miettinen K, Peuhkurinen K, et al; Kuopio Sleep Apnoea Group. The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea. J Sleep Res 2010;19:341-348.
  21. Steiropoulos P, Kotsianidis I, Nena E, et al. Long-term effect of continuous positive airway pressure therapy on inflammation markers of patients with obstructive sleep apnea syndrome. Sleep 2009;32:537-543. https://doi.org/10.1093/sleep/32.4.537
  22. Constantinidis J, Ereliadis S, Angouridakis N, Konstantinidis I, Vital V, Angouridaki C. Cytokine changes after surgical treatment of obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol 2008;265:1275-1279. https://doi.org/10.1007/s00405-008-0627-7