Is There a Correlation Between Obstructive Sleep Apnea and Periodontal Disease?

In a recent publication in the journal Clinical Oral Investigations, researchers indicated that individuals with periodontal disease demonstrated a greater incidence of severe obstructive sleep apnea (OSA), but there were no statistically noteworthy correlations.

The authors wrote, “OSA and periodontitis have coincident risk factors, such as age, smoking, diabetes mellitus, obesity, stress, and cerebrovascular events. Because the relationship has not been clearly established, studying the factors that can facilitate the progression of these pathologies continues to be of interest to the scientific community.”

This study was an observational case-control study that involved 60 patients, including 30 men and 30 women. In this study, researchers aimed to ascertain the correlation between OSA and periodontal disease and related risk factors, including local and systemic factors.

The authors indicated that all participants were assessed for local oral and systemic risk factors and were given a polysomnography test to diagnose OSA.

The study was conducted from April 2019 through March 2020, and participants were divided into four groups: two groups included patients without OSA, and two groups included patients with OSA. The four groups were comprised of 15 patients without OSA and without periodontitis, designated as group (H), 15 patients without OSA with periodontitis, defined as group (P); 15 patients with OSA without periodontitis designated as group (O); and 15 patients with OSA and with periodontitis designated as group (OP).

With regard to results, the authors indicated that among those patients diagnosed with periodontitis, almost 67% of those patients also had severe OSA.  The authors also noted that findings from other studies suggested that the incidence of periodontitis has been reported as an estimated four times higher in individuals with OSA.

With respect to oral risk factors, there were no considerable variances among the four groups with regard to the average number of present and missing teeth. The authors indicated that in evaluating the correlation between local oral risk factors associated with OSA and periodontitis, more patients that were classified as having severe OSA without periodontitis used removable partial dentures when compared to patients with severe OSA with periodontitis, and the association was substantial.

Additionally, the researchers wrote, “Patients with periodontitis with and without OSA had a higher percentage of bleeding on probing, biofilm, greater depth of gingival sulcus, periodontal pockets, and a greater loss of clinical attachment level, with statistically significant differences (p < 0.05).”

With regard to systemic risk factors, the authors discovered that obesity was recorded for 58.3% of study participants, and the greatest incidence of obesity was discovered in the group (OP) that had both OSA and periodontitis. Results also indicated that the incidence of other systemic conditions was:  arterial hypertension (28.3%), followed by hypothyroidism (16.6%), and other conditions identified among study participants included hyperlipidemia, chronic rhinitis, rheumatoid arthritis, and osteoarthritis affecting  8.3%, 5%, 3.3%, and 3% of subjects, respectively.

The authors indicated that a higher incidence of severe OSA was found in patients with periodontitis, and patients with OSA and periodontitis are more likely to be classified as obese and also diagnosed with hypothyroidism.  Additionally, individuals with OSA are more likely to have greater BMIs. Results revealed that patients with severe OSA are more likely to be diagnosed with arterial hypertension and/or osteoarthritis.

The authors concluded, “In the general population, patients with periodontitis showed a higher prevalence of severe OSA. Obesity and hypothyroidism were the most prevalent systemic findings in patients with OSA and periodontitis. Arterial hypertension and osteoarthritis were found to be associated with severe OSA. The local risk factors associated with periodontitis and severe OSA were removable partial dentures and misfit resins.”

Reference

Arango Jimenez, N., Morales Vera, D., Latorre Uriza, C. et al. Relationship of obstructive sleep apnea with the periodontal condition and its local and systemic risk factors. Clin Oral Invest (2023). https://doi.org/10.1007/s00784-023-04869-8.