An Update on the Association Between Periodontitis and Obstructive Sleep Apnea
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SYSTEMIC DISEASES (N BUDUNELI, SECTION EDITOR)
An Update on the Association Between Periodontitis and Obstructive Sleep Apnea T. Al-Jewair 1 & I. Apessos 2,3 & E. Stellrecht 4 & R. Koch 5 & B. Almaghrabi 6
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review The aim of this systematic review and meta-analysis was to update evidence answering four questions: (1) Is there an association between periodontitis and obstructive sleep apnea (OSA)? (2) Is there evidence of causality? (3) Is there a dose-response relationship between the two conditions? (4) Is there evidence on efficacy of periodontitis interventions on the occurrence and/or severity of OSA or vice versa? Recent Findings Thirteen studies were included in the qualitative analysis, and nine of them were included in the quantitative analysis. Seven studies were case-control and six were cross-sectional. All studies assessed the association between periodontitis and OSA, five studies evaluated the dose-response relation, and one examined the efficacy of periodontal interventions on OSA occurrence. There is a significant positive association between periodontitis and OSA (adjusted OR = 1.66, 95% CI,1.28, 2.17; P = 0.0002). Evidence on a dose-response gradient was conflicting. Evidence was insufficient and non-existent for efficacy of interventions and causality, respectively. Summary There is mounting evidence that supports an association between periodontitis and OSA. However, future studies are warranted to determine does-response relation, causality, and reversibility. Keywords Periodontal disease . Sleep apnea . Systematic review . Adult
Introduction Periodontitis is a severe inflammatory disease that occurs as a result of the host’s immune response to bacteria. Over time, this inflammatory state results in the destruction of alveolar bone and the loss of connective tissue, eventually leading to
tooth loss [1]. The host’s immune response through neutrophils, monocytes, B cells, and T cells recognizes bacteria and foreign entities in the periodontium. This results in the secretion of inflammatory mediators such as cytokines (tumor necrosis factor-a; TNF-a) and more specifically interleukins (IL6, IL-33, IL-1B) [1]. IL-6 and IL-1B are common cytokines
This article is part of the Topical Collection on Systemic Diseases Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40496-020-00271-5) contains supplementary material, which is available to authorized users. * T. Al-Jewair [email protected]
1
Department of Orthodontics, University at Buffalo School of Dental Medicine, 3435 Main Street, 140 Squire Hall, Buffalo, NY 14214, USA
2
212 Military Hospital of Xanthi, Xanthi, Greece
3
MSc Programme in Sleep Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
4
University at Buffalo, 3435 Main St, Buffalo, NY 14214, USA
R. Koch [email protected]
5
Department of Orthodontics, University at Buffalo School of Dental Medicine, Buffalo, NY, USA
B. Almaghrabi baa8@buf
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