A meta-analysis on the association between obstructive sleep apnea and periodontitis

Zhu, Junfei; Yuan, Xuguang; Zhang, Ying; Fang, Wei; Hou, Yinglong; Zhang, Ye

doi:10.1007/s11325-022-02668-1

Cited by 6 publications

(6 citation statements)

References 40 publications

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“…Overall, 527 records were obtained from the initial database search, with 105 being removed due to duplication. Three previous meta-analyses ( 31 - 33 ) were obtained during the literature search, and were discussed subsequently. After screening titles and abstracts of 422 studies, 395 were excluded largely due to non-relevance to the meta-analysis's objective according to the predefined inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, although significant heterogeneity was observed (I2 = 92%), the authors did not perform subgroup analyses to explore the source of heterogeneity. During the preparation of the manuscript, two meta-analyses of the similar topic are published very recently ( 32 , 33 ). These two meta-analyses, including ten observational studies published before 2021 respectively, both showed that SDB are associated with higher odds of periodontitis.…”

Section: Discussionmentioning

confidence: 99%

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Association between sleep-disordered breathing and periodontitis: a meta-analysis

Liu

Zhu²,

Zhang³

2023

Med Oral

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Background Systemic inflammation is a feature of sleep-disordered breathing (SDB) as well as periodontitis. The association between SDB and periodontitis, however, has been inconsistent in previous studies. In order to fully evaluate the above association, we conducted a meta-analysis. Material and Methods Observational studies related to the aim of the meta-analysis were identified by search of PubMed, Embase, Web of Science, Wanfang, and CNKI databases. Only studies with SDB diagnosed with the objective polysomnography examination were included. The results were analyzed using a random-effects model that incorporated potential heterogeneity between studies. Results Ten cross-sectional or case-control studies with 43,296 participants contributed to the meta-analysis. Pooled results showed that SDB was significantly associated with periodontitis (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.52 to 2.20, I2 = 40%, p < 0.001). Sensitivity analysis showed consistent association for severe periodontitis (OR: 1.39, 95% CI: 1.20 to 1.61, I2 = 0%, p < 0.001). Subgroup analyses showed consistent results in patients with mild (OR: 1.66, p < 0.001), moderate (OR: 2.23, p = 0.009), and severe SDB (OR: 2.66, p < 0.001). Moreover, the association between SDB and periodontitis was consistent in Asian and non-Asian studies, in cross-sectional and case-control studies, in studies with univariate and multivariate regression models, and in studies with different quality scores ( p for subgroup effects all < 0.05). Conclusions Polysomnography confirmed diagnosis of SDB is associated with periodontitis in adult population. Key words: Sleep-disordered breathing, periodontitis, cross-sectional studies, hypoxia, meta-analysis.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between sleep-disordered breathing and periodontitis: a meta-analysis

Liu

Zhu²,

Zhang³

2023

Med Oral

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“…Previous studies have suggested thean association between OSA and chronic periodontitis [13][14][15][16][17]. According to a cross-sectional study by Petra Stazić et al [16], higher stronger symptoms of sleep apnea were reported in OSA patients with OSA with severe periodontitis compared to patients with OSA and those with or without either mild or no periodontitis.…”

Section: Discussionmentioning

confidence: 99%

“…According to a cross-sectional study by Petra Stazić et al [16], higher stronger symptoms of sleep apnea were reported in OSA patients with OSA with severe periodontitis compared to patients with OSA and those with or without either mild or no periodontitis. According to a meta-analysis study of clinical data by Junfei Zhu et al [15], both periodontal pocket depth and clinical attachment loss clinical adhesion level (CAL) were increased higher in the OSA group compared tothan in the control group, and gingival bleeding was also increasedmore common. In addition, an in vitro study confirmed an increase in Prevotella, a specific periodontal pathogen, in the salivary microbiome structure of OSA patients;, and this result indicates that OSA patients have a high risk of chronic periodontitis [13].…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, proinflammatory immune responses may result in a bidirectional link between these two 2 diseases [12]. Accordingly, many studies have reported a significant association between OSA and chronic periodontitis [13][14][15][16][17]. In a review the results of 10 studies that includedwith an accumulatedcumulative total of 30,994 participants, periodontitis was reported to be directly related to OSA-, -but not related to severe OSA, emphasizing the need for further studies [18].…”

Section: Introductionmentioning

confidence: 99%

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Risk of chronic periodontitis in patients with obstructive sleep apnea in Korea: a nationwide retrospective cohort study

Kim¹,

Son²,

Kim³

2023

Epidemiol Health

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Objectives: The aim of this study was to determine whether the development of chronic periodontitis is more likely among patients who have been newly diagnosed with obstructive sleep apnea (OSA) through an analysis of representative data from the general population.Methods: A nationwide, population-based, retrospective cohort study was conducted using patient records from the Korean National Health Insurance Service database. For the period 2004–2019, patient data were categorized into 2 groups: a diagnosis of OSA (747 subjects) and no diagnosis of OSA (1,494 subjects). Subsequently, 1:2 propensity score matching was performed to ensure the homogeneity of the 2 groups. To analyze the risk of incident chronic periodontitis, a Cox proportional-hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs).Results: In the Kaplan-Meier curve, the disease-free probability was significantly lower in the OSA group than in the non-OSA group (P for log-rank test=0.001). The crude HR for the association between OSA and chronic periodontitis was 1.29 (95% CI, 1.16-1.43). The multivariable-adjusted HR was calculated at 1.28 (95% CI, 1.15-1.42). Conclusions: This study confirmed a relationship between OSA and chronic periodontitis. Therefore, OSA patients require oral care to prevent the progression of chronic periodontitis from mild to severe.

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Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation

Kvarnvik,

Ahonen,

Jansson

et al. 2024

Clinical & Exp Dental Res

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ObjectivesThrough inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long‐term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP).Materials and MethodsIn 2007–2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non‐CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross‐sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase‐8 (MMP‐8) chair‐side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non‐CPAP (n = 38), or adherent CPAP (n = 34) groups.ResultsThe 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP‐8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non‐CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages.ConclusionsHypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more frequently exhibited periodontal health or gingivitis compared to patients without OSA, regardless of CPAP treatment.

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A meta-analysis on the association between obstructive sleep apnea and periodontitis

Cited by 6 publications

References 40 publications

Association between sleep-disordered breathing and periodontitis: a meta-analysis

Association between sleep-disordered breathing and periodontitis: a meta-analysis

Risk of chronic periodontitis in patients with obstructive sleep apnea in Korea: a nationwide retrospective cohort study

Clinical and radiographic periodontal status in hypertensive patients with or without obstructive sleep apnea 10 years after diagnosis and CPAP initiation

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