Rapid Improvement of Blood Glucose Level after Prosthetic Mandibular Advancement in a Patient with Diabetes Mellitus and Obstructive Sleep Apnea

Abstract

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is often associated with impaired
glucose metabolism. However, the effects of Prosthetic Mandibular Advancement (PMA) on
blood glucose levels and insulin resistance remain unclear. Therefore, we assessed the immediate
effect of PMA on glycemic control measured using a Continuous Glucose Monitoring
System (CGMS) in a patient with Type 2 Diabetes Mellitus (T2DM) and OSAS.
Case presentation: A 77-year-old Japanese woman with T2DM was diagnosed with OSAS
with a Respiratory Disturbance Index (RDI) of 39.3. Because the patient did not accept Continuous
Positive Airway Pressure (CPAP) therapy, she wore a PMA that advanced the mandible
7 mm forward. Overnight sleep apnea monitoring and CGM were performed before and after
wearing the PMA. PMA induced a marked reduction in RDI from 39.3 to 12.8, an increase in
the minimum hemoglobin saturation from 78.0% to 87.0%, and a decrease in the number of
episodes of oxygen desaturation of >4% below baseline in during the bedtime from 31.3 /h to
12.1 /h. The mean glucose level markedly improved with PMA from 126.1 to 100.5 mg/dL.
Conclusion: The patient with showed improvement in RDI and glucose levels after wearing
the PMA overnight. To our knowledge, this is the first case of a patient with OSAS and T2DM
showing a beneficial effect of PMA on rapid glycemic control. CGMS may greatly help to promote
compliance with the treatment of OSAS in patients with T2DM.