Review Finds Periodontitis Associated With OSA

A contemporaneous systematic review and meta-analysis published in the Journal of Clinical and Experimental Dentistry found that periodontitis was associated with mild to moderate obstructive sleep apnea (OSA) but not severe OSA.

The investigators searched literature from inception to December 31, 2021, from Embase, PubMed, Scopus, and Web of Science. Keywords apnea or sleep apnea and periodontal or periodontitis were used in the search.

Studies with adults aged 18 and older were evaluated. Reviews, case reports, editorials, or letters to the editors; duplicate papers; surveys recruiting children; and studies that did not clearly explain the population characteristics, periodontitis definition, study outcomes, etc, were excluded.

Information on the number of subjects, mean age, number of men and women, method used for diagnosis of OSA, number with or without periodontitis, and number with or without OSA was recorded. Data related to the association between periodontitis and OSA severity were also recorded if available.

Ten studies, for a total of 30,994 participants, were included in this review. All articles were written in English and all had high or moderate quality as assessed by the Newcastle-Ottawa scale for non-randomized studies.

Analysis of the studies identified a significant association between periodontitis and OSA (odds ratio [OR], 2.17; 95% CI, 1.66-2.83) with no significant heterogeneity between the studies (I₂ = 42.7%). Meta-regression analysis did not identify publication year as a reason for heterogeneity.

Pooling the data that adjusted for possible confounders in sex and age also demonstrated a direct association between periodontitis and OSA (OR, 1.75; 95% CI, 1.65-1.85). There were 7 studies that used polysomnography for validation of OSA diagnosis that had a pooled OR of 1.31 (95% CI, 1.20-1.43), 1 study that used the Apnea-Hypopnea Index (OR, 1.59; 95% CI, 1.13-2.23), 1 study that used the STOP-Bang Questionnaire (OR, 1.28; 95% CI, 0.87-1.89), and 1 that used a self-reported measure with a nonsignificant OR of 1.02 (95% CI, 0.87-1.89).

The 3 studies that investigated the association between periodontitis and OSA severity found that periodontitis is associated with mild to moderate OSA (OR, 2.51; 95% CI, 1.32-4.78) but had no significant association with severe OSA (OR, 1.58; 95% CI, 0.70-3.58).

There were some limitations to this study. Wide 95% CIs were observed for some of the pooled estimates because of the small sample size of some of the studies; few studies reported the adjusted estimates of the association, prompting the researchers to rely on the raw data from the surveys; and the total number of studies included was not large enough. Larger reviews would be beneficial, the authors noted.

They concluded that the results of the meta-analysis identified an association between periodontitis and OSA, particularly with severe OSA. They wrote that further studies in this area are warranted to understand the mechanisms of these associations.

Reference

Khodadadi N, Khodadadi M, Zamani M. Is periodontitis associated with obstructive sleep apnea? a systematic review and meta-analysis. J Clin Exp Dent. 2022;14(4):e359-e365. doi:10.4317/jced.59478