Sleep and Breathing

, Volume 13, Issue 3, pp 233–239 | Cite as

Obstructive sleep apnoea and periodontitis: a novel association?

  • Kogulan Gunaratnam
  • Barbara Taylor
  • Bradley Curtis
  • Peter Cistulli
Original Article



Since both obstructive sleep apnoea (OSA) and periodontitis are associated with systemic inflammation and cardiovascular morbidity, we questioned whether there may be an association between these two disorders.

Materials and methods

A standard periodontal examination was undertaken in a group of 66 (54 men and 12 women) treatment-naïve patients diagnosed with OSA [apnoea–hypopnoea index (AHI) >5/h] to derive a number of quantitative variables which could then be used to determine the prevalence of periodontitis in a group of patients.


The prevalence of periodontitis in our study group was 77–79%, depending on the definition used. This was almost four times that of historical controls derived from a recent national survey. When sleep-related variables were compared against periodontal variables, significant correlations were found between periodontal clinical attachment level and total sleep time.


Our pilot study suggests that OSA is associated with periodontitis. Further research is needed to elucidate the nature of this association.


Obstructive sleep apnoea Periodontitis Prevalence Inflammation 



We thank the staff at the Royal North Shore Dental Clinic for their assistance with the periodontal examination. We thank the sleep technologists at the Department of Respiratory Medicine, Royal North Shore Hospital for their help with the data collection. We also thank Nathaniel Marshall PhD for his critical review of the manuscript.


This was not an industry-supported study. The authors have indicated no financial conflicts of interest.


  1. 1.
    Peppard PE, Young T, Palta M et al (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384 doi: 10.1056/NEJM200005113421901 PubMedCrossRefGoogle Scholar
  2. 2.
    Young T, Peppard P, Palta M et al (1997) Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 157:1746–1752 doi: 10.1001/archinte.157.15.1746 PubMedCrossRefGoogle Scholar
  3. 3.
    Nieto FJ, Young TB, Lind BK et al (2000) Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA 283:1829–1836 doi: 10.1001/jama.283.14.1829 PubMedCrossRefGoogle Scholar
  4. 4.
    Bassetti C, Aldrich MS, Chervin RD et al (1996) Sleep apnea in patients with transient ischemic attack and stroke: a prospective study of 59 patients. Neurology 47:1167–1173PubMedGoogle Scholar
  5. 5.
    Arzt M, Young T, Finn L et al (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451 doi: 10.1164/rccm.200505-702OC PubMedCrossRefGoogle Scholar
  6. 6.
    Peker Y, Kraiczi H, Hedner J et al (1999) An independent association between obstructive sleep apnoea and coronary artery disease. Eur Respir J 14:179–184 doi: 10.1034/j.1399-3003.1999.14a30.x PubMedCrossRefGoogle Scholar
  7. 7.
    Shahar E, Whitney CW, Redline S et al (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163:19–25PubMedGoogle Scholar
  8. 8.
    Mehra R, Benjamin EJ, Shahar E et al (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–916 doi: 10.1164/rccm.200509-1442OC PubMedCrossRefGoogle Scholar
  9. 9.
    Shaw JE, Punjabi NM, Wilding JP, Alberti KGMM, Zimmet PZ (2008) Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 81:2–12 doi: 10.1016/j.diabres.2008.04.025 PubMedCrossRefGoogle Scholar
  10. 10.
    Sekosan M, Zakkar M, Wenig BL et al (1996) Inflammation in the uvula mucosa of patients with obstructive sleep apnea. Laryngoscope 106:1018–1020 doi: 10.1097/00005537-199608000-00021 PubMedCrossRefGoogle Scholar
  11. 11.
    Paulsen FP, Steven P, Tsokos M et al (2002) Upper airway epithelial structural changes in obstructive sleep-disordered breathing. Am J Respir Crit Care Med 166:501–509 doi: 10.1164/rccm.2109099 PubMedCrossRefGoogle Scholar
  12. 12.
    Bergeron C, Kimoff J, Hamid Q (2005) Obstructive sleep apnea syndrome and inflammation. J Allergy Clin Immunol 116:1393–1396 doi: 10.1016/j.jaci.2005.10.008 PubMedCrossRefGoogle Scholar
  13. 13.
    Entzian P, Linnemann K, Schlaak M et al (1996) Obstructive sleep apnea syndrome and circadian rhythms of hormones and cytokines. Am J Respir Crit Care Med 153:1080–1086PubMedGoogle Scholar
  14. 14.
    Ohga E, Tomita T, Wada H et al (2003) Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1. J Appl Physiol 94:179–184PubMedGoogle Scholar
  15. 15.
    Vgontzas AN, Papanicolaou DA, Bixler EO et al (1997) Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab 82:1313–1316 doi: 10.1210/jc.82.5.1313 PubMedCrossRefGoogle Scholar
  16. 16.
    Chin K, Nakamura T, Shimizu K et al (2000) Effects of nasal continuous positive airway pressure on soluble cell adhesion molecules in patients with obstructive sleep apnea syndrome. Am J Med 109:562–567 doi: 10.1016/S0002-9343(00)00580-5 PubMedCrossRefGoogle Scholar
  17. 17.
    Dyugovskaya L, Lavie P, Lavie L (2002) Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am J Respir Crit Care Med 165:934–939PubMedGoogle Scholar
  18. 18.
    Ohga E, Nagase T, Tomita T et al (1999) Increased levels of circulating ICAM-1, VCAM-1, and L-selectin in obstructive sleep apnea syndrome. J Appl Physiol 87:10–14PubMedGoogle Scholar
  19. 19.
    Lavie L (2005) Sleep-disordered breathing and cerebrovascular disease: a mechanistic approach. Neurol Clin 23:1059–1075 doi: 10.1016/j.ncl.2005.05.005 PubMedCrossRefGoogle Scholar
  20. 20.
    Piacentini L, Karliner JS (1999) Altered gene expression during hypoxia and reoxygenation of the heart. Pharmacol Ther 83:21–37 doi: 10.1016/S0163-7258(99)00010-8 PubMedCrossRefGoogle Scholar
  21. 21.
    Kinane DF (2001) Causation and pathogenesis of periodontal disease. Periodontol 2000 25:8–20 doi: 10.1034/j.1600-0757.2001.22250102.x PubMedCrossRefGoogle Scholar
  22. 22.
    Albandar JM (2002) Global risk factors and risk indicators for periodontal diseases. Periodontol 2000 29:177–206 doi: 10.1034/j.1600-0757.2002.290109.x PubMedCrossRefGoogle Scholar
  23. 23.
    Borrell LN, Papapanou PN (2005) Analytical epidemiology of periodontitis. J Clin Periodontol 32(Suppl 6):132–158 doi: 10.1111/j.1600-051X.2005.00799.x PubMedCrossRefGoogle Scholar
  24. 24.
    Soskolne WA, Klinger A (2001) The relationship between periodontal diseases and diabetes: an overview. Ann Periodontol 6:91–98 doi: 10.1902/annals.2001.6.1.91 PubMedCrossRefGoogle Scholar
  25. 25.
    Roberts-Thomson KF, Do L (2007) Oral health status. In: Slade GD, Spencer AJ, Roberts-Thomson KF (eds) Australia’s dental generations: the National Survey of Adult Oral Health 2004–06. Australian Institute of Health and Welfare, Canberra, pp 81–142Google Scholar
  26. 26.
    Albandar JM, Brunelle JA, Kingman A (1999) Destructive periodontal disease in adults 30 years of age and older in the United States, 1988–1994. J Periodontol 70:13–29 doi: 10.1902/jop.1999.70.1.13 PubMedCrossRefGoogle Scholar
  27. 27.
    Burt B (2005) Position paper: epidemiology of periodontal diseases. J Periodontol 76:1406–1419 doi: 10.1902/jop.2005.76.8.1406 PubMedCrossRefGoogle Scholar
  28. 28.
    Al-Zahrani MS, Borawski EA, Bissada NF (2005) Periodontitis and three health-enhancing behaviors: maintaining normal weight, engaging in recommended level of exercise, and consuming a high-quality diet. J Periodontol 76:1362–1366 doi: 10.1902/jop.2005.76.8.1362 PubMedCrossRefGoogle Scholar
  29. 29.
    Buhlin K, Gustafsson A, Pockley AG et al (2003) Risk factors for cardiovascular disease in patients with periodontitis. Eur Heart J 24:2099–2107 doi: 10.1016/j.ehj.2003.09.016 PubMedCrossRefGoogle Scholar
  30. 30.
    Beck JD, Cusmano L, Green-Helms W et al (1997) A 5-year study of attachment loss in community-dwelling older adults: incidence density. J Periodontal Res 32:506–515 doi: 10.1111/j.1600-0765.1997.tb00566.x PubMedCrossRefGoogle Scholar
  31. 31.
    Borrell LN, Burt BA, Gillespie BW et al (2002) Periodontitis in the United States: beyond black and white. J Public Health Dent 62:92–101 doi: 10.1111/j.1752-7325.2002.tb03428.x PubMedCrossRefGoogle Scholar
  32. 32.
    Borrell LN, Burt BA, Neighbors HW et al (2004) Social factors and periodontitis in an older population. Am J Public Health 94:748–754 doi: 10.2105/AJPH.94.5.748 PubMedCrossRefGoogle Scholar
  33. 33.
    Mercado FB, Marshall RI, Klestov AC et al (2001) Relationship between rheumatoid arthritis and periodontitis. J Periodontol 72:779–787 doi: 10.1902/jop.2001.72.6.779 PubMedCrossRefGoogle Scholar
  34. 34.
    Ronderos M, Jacobs DR, Himes JH et al (2000) Associations of periodontal disease with femoral bone mineral density and estrogen replacement therapy: cross-sectional evaluation of US adults from NHANES III. J Clin Periodontol 27:778–786 doi: 10.1034/j.1600-051x.2000.027010778.x PubMedCrossRefGoogle Scholar
  35. 35.
    Sjostrom L, Laurell L, Hugoson A (1989) Periodontal conditions in adults with rheumatoid arthritis. Community Dent Oral Epidemiol 17:234–236 doi: 10.1111/j.1600-0528.1989.tb00623.x PubMedCrossRefGoogle Scholar
  36. 36.
    Weyant RJ, Pearlstein ME, Churak AP et al (1999) The association between osteopenia and periodontal attachment loss in older women. J Periodontol 70:982–991 doi: 10.1902/jop.1999.70.9.982 PubMedCrossRefGoogle Scholar
  37. 37.
    Janket SJ, Wightman A, Baird AE et al (2005) Does periodontal treatment improve glycemic control in diabetic patients? A meta-analysis of intervention studies. J Dent Res 84:1154–1159PubMedCrossRefGoogle Scholar
  38. 38.
    Demmer RT, Jacobs DR, Desvarieux M (2008) Periodontal disease and incident type 2 diabetes: results from the First National Health and Nutrition Examination Survey and its Epidemiologic Follow-Up Study. Diabetes Care 31:1373–1379 doi: 10.2337/dc08-0026 PubMedCrossRefGoogle Scholar
  39. 39.
    Janket SJ, Baird AE, Chuang SK et al (2003) Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 95:559–569 doi: 10.1067/moe.2003.107 CrossRefGoogle Scholar
  40. 40.
    Beck JD, Offenbacher S (2005) Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J Periodontol 76:2089–2100 doi: 10.1902/jop.2005.76.11-S.2089 PubMedCrossRefGoogle Scholar
  41. 41.
    Chun YH, Chun KR, Olguin D et al (2005) Biological foundation for periodontitis as a potential risk factor for atherosclerosis. J Periodontal Res 40:87–95 doi: 10.1111/j.1600-0765.2004.00771.x PubMedCrossRefGoogle Scholar
  42. 42.
    Beck J, Garcia R, Heiss G et al (1996) Periodontal disease and cardiovascular disease. J Periodontol 67:1123–1137PubMedGoogle Scholar
  43. 43.
    Badersten A, Nilveus R, Egelberg J (1981) Effect of nonsurgical periodontal therapy. I. Moderately advanced periodontitis. J Clin Periodontol 8:57–72 doi: 10.1111/j.1600-051X.1981.tb02024.x PubMedCrossRefGoogle Scholar
  44. 44.
    Lobene RR, Weatherford T, Ross NM, Lamm RA, Menaker L et al (1986) A modified gingival index for use in clinical trials. Clin Prev Dent 8:3–6PubMedGoogle Scholar
  45. 45.
    Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135 doi: 10.3109/00016356408993968 PubMedCrossRefGoogle Scholar
  46. 46.
    (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22:667–689Google Scholar
  47. 47.
    Mayfield L, Bratthall G, Attstrom R (1999) Periodontal probe precision using 4 different periodontal probes. J Clin Periodontol 23:76–82 doi: 10.1111/j.1600-051X.1996.tb00538.x CrossRefGoogle Scholar
  48. 48.
    Dupont WD, Plummer WD Jr (1990) Power and sample size calculations. A review and computer program. Control Clin Trials 11:116–128 doi: 10.1016/0197-2456(90)90005-M PubMedCrossRefGoogle Scholar
  49. 49.
    Dupont WD, Plummer WD Jr (1990) Power and sample size calculations for studies involving linear regression. Control Clin Trials 19:589–601 doi: 10.1016/S0197-2456(98)00037-3 CrossRefGoogle Scholar
  50. 50.
    Andriankaja OM, Genco RJ, Dorn J et al (2006) The use of different measurements and definitions of periodontal disease in the study of the association between periodontal disease and risk of myocardial infarction. J Periodontol 77:1067–1073 doi: 10.1902/jop.2006.050276 PubMedCrossRefGoogle Scholar
  51. 51.
    Tonetti MS, Claffey N (2005) European Workshop in Periodontology group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th European Workshop in Periodontology. J Clin Periodontol 32(Suppl 6):210–213 doi: 10.1111/j.1600-051X.2005.00822.x PubMedCrossRefGoogle Scholar
  52. 52.
    ABS (2006) National Health Survey, 2004–2005. Australian Bureau of Statistics, CanberraGoogle Scholar
  53. 53.
    Reichmuth KJ, Austin D, Skatrud JB et al (2005) Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 172:590–595 doi: 10.1164/rccm.200504-637OC CrossRefGoogle Scholar
  54. 54.
    ABS (2008) Regional wage and salary earner statistics, Australia, 2003–04. Australian Bureau of Statistics, CanberraGoogle Scholar
  55. 55.
    ABS (2008) 2008 Year Book Australia. Australian Bureau of Statistics, CanberraGoogle Scholar
  56. 56.
    Torrungruang K, Tamsailom S, Rojanasomsith K et al (2005) Risk indicators of periodontal disease in older Thai adults. J Periodontol 76:558–565 doi: 10.1902/jop.2005.76.4.558 PubMedCrossRefGoogle Scholar
  57. 57.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239 doi: 10.1164/rccm.2109080 PubMedCrossRefGoogle Scholar
  58. 58.
    Koutsourelakis I, Vagiakis E, Roussos C et al (2006) Obstructive sleep apnoea and oral breathing in patients free of nasal obstruction. Eur Respir J 28:1222–1228 doi: 10.1183/09031936.00058406 PubMedCrossRefGoogle Scholar
  59. 59.
    Oeverland B, Akre H, Skatvedt O (2002) Oral breathing in patients with sleep-related breathing disorders. Acta Oto-Laryngol 122:651–654 doi: 10.1080/000164802320396349 CrossRefGoogle Scholar
  60. 60.
    Wagaiyu EG, Ashley FP (1991) Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11–14 year-old schoolchildren. J Clin Periodontol 18:698–702 doi: 10.1111/j.1600-051X.1991.tb00112.x PubMedCrossRefGoogle Scholar
  61. 61.
    Jacobson L, Linder-Aronson S (1972) Crowding and gingivitis: a comparison between mouthbreathers and nosebreathers. Scand J Dent Res 80:500–514PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kogulan Gunaratnam
    • 1
  • Barbara Taylor
    • 2
    • 3
  • Bradley Curtis
    • 4
  • Peter Cistulli
    • 5
    • 6
    • 7
  1. 1.Discipline of Periodontics, Faculty of DentistryUniversity of SydneySydneyAustralia
  2. 2.Department of PeriodonticsSydney Dental HospitalSydneyAustralia
  3. 3.School of Dentistry and Health SciencesCharles Sturt UniversityWagga WaggaAustralia
  4. 4.Community Oral Health and Epidemiology, Faculty of DentistryUniversity of SydneySydneyAustralia
  5. 5.Department of Respiratory MedicineRoyal North Shore HospitalSt. LeonardsAustralia
  6. 6.Faculty of MedicineUniversity of SydneySydneyAustralia
  7. 7.Woolcock Institute of Medical ResearchSydneyAustralia

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