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Cardiometabolic Effects of Obstructive Sleep Apnea and Treatment Effects of Oral Appliance: An Updated Review for Dentists
J Oral Med Pain 2018;43:61-69
Published online September 30, 2018;
© 2018 Korean Academy of Orofacial Pain and Oral Medicine

Hye-Kyoung Kim, Mee-Eun Kim

Department of Oral Medicine, College of Dentistry, Dankook University, Cheonan, Korea
Correspondence to: Mee-Eum Kim
Department of Oral Medicine, College of Dentistry, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea
Tel: +82-41-550-1915
Fax: +82-505-434-7951
Received June 14, 2018; Revised August 24, 2018; Accepted August 29, 2018.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Obstructive sleep apnea (OSA) is a relatively common, but greatly underdiagnosed sleep-related breathing disorder, characterized by recurrent collapse of the upper airway during sleep. OSA has been associated with a variety of cardiometabolic disease, such as hypertension, coronary artery disease, cardiac arrhythmia, cerebrovascular disease and metabolic dysfunction. Neurocognitive impairment, including excessive daytime sleepiness, increased risk of motor vehicle accidents, is also related to OSA. Sleep fragmentation and related arousals during sleep lead to intermittent hypoxia, sympathetic activation, oxidative stress, systemic inflammation and metabolic dysregulation which provide biological plausibility to this pathologic mechanism. Extensive studies demonstrated that OSA is a modifiable risk factor for the above mentioned diseases and oral appliances (OAs), although continuous positive air pressure (CPAP) is a first-line therapy of OSA, are not inferior to CPAP at least in mild OSA, and may be an alternative to CPAP in CPAP-intolerant subjects with OSA. The goal of this article is to provide a current knowledge of pathologic link between OSA and cardiovascular disease, focusing on intermittent hypoxia, sympathetic activation, oxidative stress and metabolic dysregulation. Then, previous epidemiologic studies will be reviewed to understand the causal relationship between OSA and cardiovascular disease. Finally, the effects of OAs will be updated via recent meta-analyses compared to CPAP.
Keywords : Cardiovascular; Mandibular advancement device; Obstructive sleep apnea; Oral appliance

March 2019, 44 (1)