Association between obstructive sleep apnea and periodontitis in Chinese male adults: A cross-sectional study

Abstract

Obstructivesleep apnea (OSA), characterized by periodic and repetitive collapse of the upper airway during sleep, is a common disease with an estimated prevalence of 3% to 7% worldwide. 1 Patients with OSA undergo apnea and/or hypopnea, resulting in hypoxia, hypercapnia, sleep fragmentation, increased sympathetic activity, and altered immunity. 2,3 According to the American Academy of Sleep Medicine's (AASM) clinical practice guidelines, the management of patients by dentists through oral prosthesis therapy is accepted as an appropriate treatment. 4 An oral appliance has also been an effective treatment for OSA, improving not only OSA symptoms but also a variety of physiologic and behavioral outcomes. 5 Periodontitis is a disease with high prevalence, which affects 10.8% of the adult population worldwide. 6 The fourth National Oral Health Survey in China identified a periodontitis frequency of 52.8% in the 35-to 44-year age group. 7 Periodontitis is a chronic infectious and inflammatory disease caused by bacterial pathogens that initiate an inflammatory response from the host. 8 The synergetic effect of bacterial toxins and host immune response results in the destruction of periodontal tissues, manifested clinically as loss of alveolar bone, progressive loss of periodontal attachment, pocket formation, and, ultimately, tooth loss. 9

Is periodontitis associated with obstructive sleep apnea? A systematic review and meta-analysis

“…The search strategy initially recovered 265 citations. After excluding duplicates, as well as those not meeting the inclusion criteria, a total of 10 studies containing 30,994 participants were finally included ( 7 - 10 , 18 - 23 ). The search results have been represented in a flow diagram as per the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guideline (Fig.…”

“…The agreement between the investigators for the eligibility judgment was excellent (Kappa statistic=0.88). Three studies had a high quality ( 8 , 10 , 21 ) and seven studies had a moderate quality ( 7 , 9 , 18 - 20 , 22 , 23 ). The baseline characteristics, as well as quality assessment, of the included papers have been summarized in Table 1 .…”

“…For validation of OSA diagnosis, seven studies used polysomnography with a pooled OR of 1.31 (95% CI: 1.20-1.43; I2=12.2%, p =0.336) ( 7 , 9 , 18 - 22 ), one study used AHI with an OR of 1.59 (95% CI: 1.13-2.23) ( 8 ), another study used STOP-Bang Questionnaire with a non-significant OR of 1.28 (95% CI: 0.87-1.89) ( 23 ), and another one used a self-reported measure with a non-significant OR of 1.02 (95% CI: 0.76-1.38) ( 10 ).…”

“…Analysis of these surveys indicated that periodontitis is significantly associated with mild-to-moderate OSA (OR=2.51, 95% CI: 1.32-4.78; I2=0.0%, p =0.527); on the other hand, no significant association was identified between periodontitis and severe OSA (OR=1.58, 95% CI: 0.70-3.58; I2=0.0%, p =0.469). In addition, there were three other studies evaluating the correlation between CAL and AHI ( 7 , 18 , 22 ); pooling these data demonstrated that periodontitis had a non-significant positive correlation with OSA severity (r=+0.277, p =0.062; I2=47.8%, p =0.147).…”

Association between sleep-disordered breathing and periodontal diseases: A systematic review protocol

“…Several studies have reported a significant association between SDB and periodontitis ( 17 , 25 , 26 ). An observational study found that the risk of periodontitis in patients at high risk of OSA was approximately double that at low risk of OSA ( 27 ).…”