ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title No Relationship Between Obstructive Sleep Apnea and Premolar Extraction
Clinical Question In orthodontically treated patients, does extracting one premolar from each quadrant contribute to increased prevalence of obstructive sleep apnea as compared to patients with no extractions?
Clinical Bottom Line The evidence supports no relationship between premolar extractions and obstructive sleep apnea.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26235151Larsen/20155,584 patients between 40 and 70 years oldRetrospective medical records review
Key resultsKey Results: 5,584 randomly selected subjects were divided into two equal groups of 2,792. One group had four missing premolars (one in each quadrant) and the other group did not. Subjects were paired 1:1 based on BMI group, gender, and age group. Polysomnography confirmed the presence of OSA in the OSA positive group. 9.56% of patients with no missing premolars were diagnosed with OSA. 10.71% of patients who were missing premolars were diagnosed with OSA. A p-value of 0.144 indicated that there was no significant difference between the groups. The investigators concluded that a history of premolar extraction does not significantly predispose patients to OSA as compared to patients who did not have premolar extraction.
Evidence Search (premolar extraction) AND obstructive sleep apnea
Comments on
The Evidence
This retrospective study used data from HealthPartners’ claims repository and health records. The sample groups were matched based on their age, BMI and gender, which increased the quality of the data due to the fact that these are high risk factors for OSA. The data validation process supported the quality of the data. The very large sample size (5,584) helped support the study's findings. One limitation to this study was sample bias. In the general population, 80%-90% of patients with OSA are undiagnosed. Although each one of the 5,584 subjects did not undergo a PSG to rule out undiagnosed OSA, every subject in this study had access to medical consults and PSG. This theoretically limited the percentage of patients with undiagnosed OSA and supported the validity of the study model and findings. This study did not have access to information regarding the skeletal characteristics of the subjects or what type, if any, orthodontic treatment the subjects had undergone. Future studies are needed to help address these issues.
Applicability This study provides practitioners with more information about the long-term effects of premolar extractions and guidance for choosing the best orthodontic treatment modalities for the patient. The clinical bottom line of the study is that there is no relationship between obstructive sleep apnea and premolar extractions. Although patient selection remains an important factor when considering patient's susceptibility to OSA, premolar extractions should not be considered a risk factor for OSA.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics)
Keywords Obstructive sleep apnea, premolar extraction, orthodontic treatment
ID# 2917
Date of submission: 09/23/2015spacer
E-mail laughinghous@livemail.uthscsa.edu
Author Megan Laughinghouse
Co-author(s) Satoko Hasegawa
Co-author(s) e-mail HasegawaS@livemail.uthscsa.edu
Faculty mentor/Co-author Kelly C. Lemke, DDS
Faculty mentor/Co-author e-mail LemkeK@uthscsa.edu
Basic Science Rationale
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