ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Periodontal Disease Is More Prevalent In Patients Who Have Sleep Disorders
Clinical Question Is periodontal disease more prevalent in patients with sleep disorders compared to patients without sleep disorders?
Clinical Bottom Line Patients that have sleep disorders are more susceptible to periodontal disease. This is based on a retrospective population-based cohort study and systematic review of 6 studies that identified the increased incidence of periodontitis in patients with sleep apnea and non-sleep apnea sleep disorders.
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) 25801281Al-Jewair/201430,130 patients/6 studiesMeta-Analysis
Key resultsSix studies were reviewed. Four studies validated the obstructive sleep apnea (OSA) diagnosis with laboratory-based polysomnography. One study used the laboratory-based polysomnography in addition to home-based sleep testing. The other study used self-administered validated questionnaires to determine the level of OSA. The studies reviewed measured periodontal disease using clinical attachment loss, periodontal probing depth, and radiographically assessed alveolar bone loss. Some studies also used levels of salivary inflammatory mediators to determine periodontal disease. The pooled odds ratio for an association between periodontal disease and OSA was 1.65 (95% confidence interval [CI]=1.11 to 2.46; P=0.01).
#2) 24059676Lee/2014127,569 patients (46,227 males age 18-25 years; 81,342 females 18-95 yearsRetrospective Population-based Cohort Study
Key resultsPatients with non-apnea sleep disorders had a 39% higher incidence of severe periodontal disease, with a higher incidence in males than females.
Evidence Search ("sleep apnoea"[All Fields] OR "sleep apnea syndromes"[MeSH Terms] OR ("sleep"[All Fields] AND "apnea"[All Fields] AND "syndromes"[All Fields]) OR "sleep apnea syndromes"[All Fields] OR ("sleep"[All Fields] AND "apnea"[All Fields]) OR "sleep apnea"[All Fields]) AND ("periodontitis"[MeSH Terms] OR "periodontitis"[All Fields]); "sleep wake disorders"[MeSH Terms] AND "periodontal diseases"[MeSH Terms]
Comments on
The Evidence
Validity: The systemic review and cohort study listed the number of studies and number of patients, respectively. The systemic review listed search parameters in addition to the screening criteria used to create the research, and included articles were assessed for quality. Both studies had extensive data analysis.The authors stated no conflicts of interest. Perspective: The studies showed that sleep apnea and non-sleep apnea sleep disorders had an association with periodontal disease. Further research is necessary due to biases in the cohort study and in the studies evaluated in the systemic review. These biases relate to the calibration of the measurements and to a consistent definition of periodontitis. In addition, in the cohort study, multivariate analysis included variables related to comorbidities including hypertension, coronary artery disease, congestive heart failure, diabetes, chronic kidney disease, and hyperlipidemia; however, analyses were not adjusted for other potential confounders such as smoking or drinking alcohol.
Applicability A review of the medical history can help identify patients with sleep disorders. Patients with sleep disorders will need to be monitored closely during recall visits and given proper oral health care instructions in order to help combat the increased risk of periodontitis.
Specialty/Discipline (Public Health) (General Dentistry) (Periodontics)
Keywords Periodontitis, sleep disorders, obstructive sleep apnea, non-obstructive sleep apnea
ID# 3028
Date of submission: 03/23/2016spacer
E-mail jonesc8@livemail.uthscsa.edu
Author Christopher Jones
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author e-mail finlaysonr@uthscsa.edu
Basic Science Rationale
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