A Systematic Review on Sleep Related Disorders and Periodontal Disease
Abstract
BACKGROUND: Periodontitis has been implicated in many systemic diseases such as diabetes, cardiovascular diseases, hypertension, stroke, Obesity, Kidney disorders. Recent scientific evidence has revealed a relationship between sleep related breathing disorders (SRBDs) and periodontal diseases. There has been a recent scientific evidence on population based studies reflecting an association between periodontal diseases and OSA.
AIM: The tenet of the study was to find out interconnect between obstructive sleep apnea and periodontal disease.
METHODS: A systematic review of clinical trials assessing the relationship between OSA and periodontitis was carried out. An electronic search based on internet search sites (From 2000-2016) by PubMed, MEDLINE, SCOPUS, EMBASE, Google scholar, CINAHL, and Web of Science (WoS) were used. Studies which met the inclusion criteria were further analysed to find out the outcome of the study.
RESULTS: A total of 174 potentially qualifying studies were screened. Out of them 10 studies fulfilled the inclusion criteria which were further analysed. In our study 10 studies (2000-2016) from Jordan, Tokyo, Turkey, Saudi Arabia, India, USA, South Korea, Taiwan, Australia were shortlisted. Out of them 5 were cross sectional studies, 4 were case control, and 1 was meta-analysis. The sample size in the studies ranged from 66 to 30,120 adult falling in age range of 18 to 75. The indicators for OSA used were as positive Epsworth sleepiness scale (ESS), Berlin Questionnaire, STOP-bang questionnaire, Apnea-Hypopnea index, Polysomnography (PSG). And the indicators for periodontal disease were Plaque index (PI), Clinical attachment level (CAL), Pocket Probing Depth (PPD), Gingival Bleeding Index (GBI). Majority of studies showed positive correlation between OSA and periodontal disease.
CONCLUSION: Recent evidence and literature suggests that there exist a strong interconnect between OSA and periodontal disease. Dentist play a pivotal role in diagnosis and timely management of OSA cases so as to halt progression of sleep apnea and periodontitis.
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References
Haffajee AD, Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontology 1994 ;5(1):78-111.
Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. Journal of periodontology 1999;70(1):1329.
Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Annals of periodontology 1998;3(1):51-61.
Lőe H. Periodontal disease. The sixth complication of diabetes mellitus. Diabetes Care, 1993;16 :329-33410.
Fogel RB, Malhotra A, White DP. Sleep 2: pathophysiology of obstructive sleep apnea/hypopnoea syndrome. Thorax 2004;59:159-63.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20(9):705-6.
Gunaratnam K, Taylor B, Curtis B, Cistulli P. Obstructive sleep apnoea and periodontitis: A novel association? Sleep Breath. 2009;13:233-9.
Kellar JJ, Wu CS, Chen YH, Lin HC. Association between Obstructive sleep and chronic Periodontitis: a population - based study. J Periodontol. 2013;40: 111-7.
Arora SA, Chhina S, Goel A, Mishra S, Kazim J. Interconnect between Periodontal disease & day time somnolence: A cross sectional study. NJIRM 2015;6(5):1-8.
Oksenberg A, Froom P, Melamed S. Dry mouth upon awakening in obstructive sleep apnea. J Sleep Res. 2006;15(3):317-20.
Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation 2005;112(17):2660-7.
Gharibeh T, Mehra R. Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options. Nat Sci Sleep. 2010;2:233-55.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14(6):540-5.
Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-91.
Ong TH, Raudha S, Fook-Chong S, Lew N, Hsu AAL. Simplifying STOP-Bang: use of a simple questionnaire to screen for OSA in an Asian population. Sleep Breath 2010;14:3716.
Iber C, Ancoli-Israel S, Chesson A. "Quan SF, for the American Academy of Sleep Medicine: The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications." (2007).
Al Habashneh R, Khassawneh B, Khader YS, Abu-Jamous Y, Kowolik MJ. Association Between Obstructive Sleep Apnea and Periodontitis Among Male Adults Attending a Primary Healthcare Facility in Jordan. Oral health & preventive dentistry 2015;14(2):157-64.
Suzuki S, Kojima Y, Takayanagi A, Yoshino K, Ishizuka Y, Satou R, et al. Relationship between
Obstructive Sleep Apnea and Self-assessed Oral Health Status: An Internet Survey. The Bulletin of Tokyo Dental College. 2016;57(3):175-81.
Gamsiz-Isik H, Kiyan E, Bingol Z, Baser U, Ademoglu E, Yalcin F. Does Obstructive Sleep Apnea Increase the Risk for Periodontal Disease?: A Case-control Study. J Periodontol. 2016; 18:1-8.
Loke W, Girvan T, Ingmundson P, Verret R, Schoolfield J, Brian LM. Investing the Association between Obstructive Sleep Apnea and Periodontitis. J Periodontol 2015; 86: 232-243.
Seo WH, Cho ER, Thomas RJ, An SY, Ryu JJ, Kim H, Shin C. The association between periodontitis and obstructive sleep apnea: a preliminary study. Journal of periodontal researcht2013;48(4):500-6.
Al-Jewair TS, Al-Jasser R, Almas K. Periodontitis and obstructive sleep apnea’s bidirectional relationship: a systematic review and meta-analysis. Sleep and Breathing. 2015;19(4):1111-20.
Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: a two-way relationship. Annals of periodontology 1998;3(1):51-61.
Punjabi NM, Ahmed MM, Polotsky VY, Gottlieb DJ, Givelber R, Resnick HE, et al. Sleep disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol. 2003;136(2-3):167-78.
Nizam N, Basoglu OK, Tasbakan MS, Nalbantsoy A, Buduneli N. Salivary cytokines and the association between obstructive sleep apnea syndrome and periodontal disease. J Periodontol 2014;85:251-8.
Howells GL. Cytokine networks in destructive periodontal disease. Oral Dis 1995;1:266–270.
Loos BG. Systemic markers of inflammation in periodontitis. J Periodontol 2005;76:2106-15.
Shamsuzzaman AS, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, et al. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002;105(21):2462-4.
Ryan S, Taylor CT, McNicholas WT. Selective activation of inflammatory pathways by intermittent hypoxia in obstructive sleep apnea syndrome. Circulation, 2005;112(17):2660-7.
Nizam N, Basoglu OK , Tasbakan MS , Holthöfer A, Tervahartiala T, Sorsa T, et al. 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 2014;60:134-43.
