Sleep and Breathing

, Volume 20, Issue 3, pp 1095–1102 | Cite as

Tooth loss and obstructive sleep apnea signs and symptoms in the US population

  • Anne E. SandersEmail author
  • Aderonke A. Akinkugbe
  • Gary D. Slade
  • Greg K. Essick
Epidemiology • Original Article



The aim of this study is to investigate the relationship between tooth loss and signs and symptoms of obstructive sleep apnea (OSA) in a representative sample of the general US population.


Data were from 7305 men and women aged ≥25 years participating in the 2005–2008 National Health and Nutrition Examination Survey. Tooth loss, occlusal contacts, and denture use were determined by dental examination. Four cardinal OSA signs and symptoms were evaluated by questions based on American Academy of Sleep Medicine criteria. Adults with ≥2 signs/symptoms of OSA were classified at high-risk of OSA. Prevalence ratios (PR) and 95 % confidence limits (CL) from log binomial regression models estimated the strength of association between tooth loss and high-risk for OSA, adjusting for demographic characteristics, body mass index, dentures, and sleep duration.


Prevalence of high-risk for OSA increased 2 % for each additional lost tooth (PR = 1.02, 95 % CL, 1.01, 1.03) among adults aged 25 to 65 years. When tooth loss was modeled as an ordinal variable with 0–4 lost teeth as the referent category, adjusted prevalence of high-risk for OSA was as follows: 25 % greater in those missing 5–8 teeth (PR = 1.25, 95 % CL, 1.07, 1.46); 36 % greater in those missing 9–31 teeth (PR = 1.36, 95 % CL, 1.06, 1.73); and 61 % greater in the edentulous (PR = 1.61, 95 % CL, 1.11, 2.33).


Tooth loss may be an independent risk factor for OSA.


Epidemiology Population Tooth loss Oral health Sleep-disordered breathing NHANES 



Akinkugbe A.A. was supported by the National Institute of Health NRSA T90 Training Grant NIH/ NIDCR (5T90DE021986).

Compliance with ethical standards

Data collection protocols were approved by the Centers for Disease Control and Prevention/National Center for Health Statistics Ethics Review Board and all participants gave informed consent.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Anne E. Sanders
    • 1
    Email author
  • Aderonke A. Akinkugbe
    • 2
  • Gary D. Slade
    • 1
  • Greg K. Essick
    • 3
  1. 1.Department of Dental Ecology, School of DentistryUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Epidemiology, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Prosthodontics and Center for Pain Research and Innovation, School of DentistryUniversity of North Carolina at Chapel HillChapel HillUSA

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