Skip to main content

Advertisement

SpringerLink
Log in

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

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

The present meta-analysis aimed to evaluate quantitively the recent scientific evidence regarding the association between obstructive sleep apnea (OSA) and periodontitis.

Methods

Databases searched were PubMed, EMBASE, Scopus, and Web of Science. Publications were included according to the inclusion criteria. The following outcomes were evaluated: the prevalence of periodontitis, probing depth (PD), clinical attachment loss (CAL), the percentage of sites with bleeding on probing (BOP), plaque index (PI), and gingival index (GI). The statistical analysis was processed using the software STATA.

Results

Thirteen eligible studies comprising a total of 31,800 patients were included. The meta-analysis showed an increased prevalence of periodontitis in OSA populations compared to controls. Both PD and CAL were increased in OSA populations compared with controls. (Prevalence of periodontitis: OR 2.348; 95%CI 2.221–2.482; PD: SMD = 0.681, 95% CI: 0.062–1.301, Z = 2.61, P = 0.031; CAL: SMD = 0.694, 95% CI: 0.167–1.22, Z = 2.58, P = 0.01). The study also found significantly increased BOP in patients with OSA after heterogeneity was clarified. (SMD = 0.357, 95% CI: 0.079–0.635, Z = 2.52, P = 0.012).

Conclusions

The findings suggest that OSA was associated with an increased prevalence of periodontitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Slots J (2017) Periodontitis: facts, fallacies and the future. Periodontol 2000 75(1):7–23

    Article  PubMed  Google Scholar 

  2. Fischer RG et al (2020) Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis. Braz Oral Res 34(1):e026

    Article  PubMed  Google Scholar 

  3. Shangase SL et al (2013) The association between periodontitis and systemic health: an overview. Sadj 68(1):8, 10-2

    CAS  PubMed  Google Scholar 

  4. Gunaratnam K et al (2009) Obstructive sleep apnoea and periodontitis: a novel association? Sleep Breath 13(3):233–239

    Article  PubMed  Google Scholar 

  5. Maspero C et al (2015) Obstructive sleep apnea syndrome: a literature review. Minerva Stomatol 64(2):97–109

    CAS  PubMed  Google Scholar 

  6. Kheirandish-Gozal L, Gozal D (2019) Obstructive sleep apnea and inflammation: proof of concept based on two illustrative cytokines. Int J Mol Sci 20(3):459. https://doi.org/10.3390/ijms20030459

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Liu X et al (2020) The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome. J Neuroinflamm 17(1):229

    Article  Google Scholar 

  8. Paschetta E et al (2015) OSAS-related inflammatory mechanisms of liver injury in nonalcoholic fatty liver disease. Mediators Inflamm 2015:815721

    Article  PubMed  PubMed Central  Google Scholar 

  9. Quercioli A, Mach F, Montecucco F (2010) Inflammation accelerates atherosclerotic processes in obstructive sleep apnea syndrome (OSAS). Sleep Breath 14(3):261–269

    Article  PubMed  Google Scholar 

  10. Al Habashneh R et al (2016) Association between obstructive sleep apnea and periodontitis among male adults attending a primary healthcare facility in Jordan. Oral Health Prev Dent 14(2):157–164

    PubMed  Google Scholar 

  11. Durhan M et al (2019) Does obstructive sleep apnea affect oral and periodontal health in children with down syndrome? A preliminary study. Niger J Clin Pract 22(9):1175–1179

    Article  CAS  PubMed  Google Scholar 

  12. Gamsiz-Isik H et al (2017) Does obstructive sleep apnea increase the risk for periodontal disease? A case-control study. J Periodontol 88(5):443–449

    Article  CAS  PubMed  Google Scholar 

  13. Kale SS, Kakodkar P, Shetiya SH (2018) Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college - a cross sectional study. Sleep Sci 11(2):112–117

    Article  PubMed  PubMed Central  Google Scholar 

  14. Latorre C et al (2018) Association between obstructive sleep apnea and comorbidities with periodontal disease in adults. J Indian Soc Periodontol 22(3):215–220

    Article  PubMed  PubMed Central  Google Scholar 

  15. Al-Jewair TS, Al-Jasser R, Almas K (2015) Periodontitis and obstructive sleep apnea’s bidirectional relationship: a systematic review and meta-analysis. Sleep Breath 19(4):1111–1120

    Article  PubMed  Google Scholar 

  16. Zhu J et al (2017) Association of circulating leptin and adiponectin with periodontitis: a systematic review and meta-analysis. BMC Oral Health 17(1):104

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zhu J et al (2016) Interleukin-6-174G/C Polymorphism contributes to periodontitis susceptibility: an updated meta-analysis of 21 case-control studies. Dis Markers 2016:9612421

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ahmad NE et al (2013) Obstructive sleep apnea in association with periodontitis: a case-control study. J Dent Hyg 87(4):188–199

    PubMed  Google Scholar 

  19. Ai-Hammad NS, Hakeem LA, Salama FS (2015) Oral health status of children with obstructive sleep apnea and snoring. Pediatr Dent 37(1):35–39

    Google Scholar 

  20. Keller JJ et al (2013) Association between obstructive sleep apnoea and chronic periodontitis: a population-based study. J Clin Periodontol 40(2):111–117

    Article  PubMed  Google Scholar 

  21. Loke W et al (2015) Investigating the association between obstructive sleep apnea and periodontitis. J Periodontol 86(2):232–243

    Article  PubMed  Google Scholar 

  22. Nizam N et al (2016) Is there an association between obstructive sleep apnea syndrome and periodontal inflammation? Clin Oral Invest 20(4):659–668

    Article  CAS  Google Scholar 

  23. Sales-Peres SHC et al (2016) Periodontal status in morbidly obese patients with and without obstructive sleep apnea syndrome risk: a cross-sectional study. J Periodontol 87(7):772–782

    Article  PubMed  Google Scholar 

  24. Seo WH et al (2013) The association between periodontitis and obstructive sleep apnea: a preliminary study. J Periodontal Res 48(4):500–506

    Article  CAS  PubMed  Google Scholar 

  25. Al-Jewair T et al (2020) An update on the association between periodontitis and obstructive sleep apnea. Curr Oral Health Rep 7(3):189–201

    Article  Google Scholar 

  26. Bradley TD, Floras JS (2009) Obstructive sleep apnoea and its cardiovascular consequences. Lancet 373(9657):82–93

    Article  PubMed  Google Scholar 

  27. Hegde S et al (2019) Obesity and its association with chronic periodontitis: a cross-sectional study. J Educ Health Promot 8:222

    PubMed  PubMed Central  Google Scholar 

  28. Nizam N et al (2015) Do salivary and serum collagenases have a role in an association between obstructive sleep apnea syndrome and periodontal disease? A preliminary case-control study. Arch Oral Biol 60(1):134–143

    Article  CAS  PubMed  Google Scholar 

  29. Carra MC (2019) Obstructive sleep disordered breathing, sleep bruxism and periodontal diseases. Orthod Fr 90(3–4):301–310

    Article  PubMed  Google Scholar 

  30. Maluly M et al (2020) Sleep bruxism and its associations with insomnia and OSA in the general population of Sao Paulo. Sleep Med 75:141–148

    Article  CAS  PubMed  Google Scholar 

  31. Ono Y et al (2008) Effects of sleep bruxism on periodontal sensation and tooth displacement in the molar region. Cranio 26(4):282–286

    Article  PubMed  Google Scholar 

  32. Restrepo CC, Tirado M, Jimenez KJ (2016) Association of sleep bruxism and dental plaque factors on signs of periodontal disease in children in the mixed dentition. Int J Paediatr Dent 26(6):477–485

    Article  PubMed  Google Scholar 

  33. Alexander AG (1970) Habitual mouthbreathing and its effect on gingival health. Parodontologie 24(2):49–55

    CAS  PubMed  Google Scholar 

  34. Dewan NA, Nieto FJ, Somers VK (2015) Intermittent hypoxemia and OSA: implications for comorbidities. Chest 147(1):266–274

    Article  PubMed  PubMed Central  Google Scholar 

  35. Karatas O et al (2020) Evaluation of apoptosis and hypoxia-related factors in gingival tissues of smoker and non-smoker periodontitis patients. J Periodontal Res 55(3):392–399

    Article  CAS  PubMed  Google Scholar 

  36. Celik D, Kantarci A (2021) Vascular changes and hypoxia in periodontal disease as a link to systemic complications. Pathogens 10(10):1280. https://doi.org/10.3390/pathogens10101280

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Liu KZ et al (2014) Assessment of tissue oxygenation of periodontal inflammation in smokers using optical spectroscopy. J Clin Periodontol 41(4):340–347

    Article  CAS  PubMed  Google Scholar 

  38. Zhang C et al (2014) Assessment of tissue oxygenation of periodontal inflammation in patients with coronary artery diseases using optical spectroscopy. BMC Oral Health 14:25

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sehirli A et al (2021) The circadian clock gene Bmal1: role in COVID-19 and periodontitis. Chronobiol Int 38(6):779–784

    Article  CAS  PubMed  Google Scholar 

  40. Yang MY et al (2019) Alternations of circadian clock genes expression and oscillation in obstructive sleep apnea. J Clin Med 8(10):1634. https://doi.org/10.3390/jcm8101634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Janjić K et al (2017) Expression of circadian core clock genes in fibroblasts of human gingiva and periodontal ligament is modulated by L-mimosine and hypoxia in monolayer and spheroid cultures. Arch Oral Biol 79:95–99

    Article  PubMed  Google Scholar 

  42. Kapur VK et al (2017) Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice guideline. J Clin Sleep Med 13(3):479–504

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

China-Japan hospital provided financial support in the form of hospital-level funding. The sponsor had no role in the design or conduct of this research.

Author information

Author notes

  1. Junfei Zhu and Xuguang Yuan contributed equally to this work.

Authors and Affiliations

  1. Stomatology Center of China Japan Friendship Hospital, Beijing, China

    Junfei Zhu, Xuguang Yuan, Fang Wei & Ye Zhang

  2. Department of Anesthesia, China Japan Friendship Hospital, Beijing, China

    Ying Zhang & Yuli Hou

Authors
  1. Junfei Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xuguang Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fang Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuli Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ye Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ye Zhang.

Ethics declarations

Ethics approval

For this type of study, ethical approval is not required.

Informed consent

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhu, J., Yuan, X., Zhang, Y. et al. A meta-analysis on the association between obstructive sleep apnea and periodontitis. Sleep Breath 27, 641–649 (2023). https://doi.org/10.1007/s11325-022-02668-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-022-02668-1

Keywords

Search

Navigation