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J Dent Hyg. 2013 Aug;87(4):188-99.

Obstructive sleep apnea in association with periodontitis: a case-control study.



Periodontitis is associated with several cardio-metabolic disorders that are co-morbid with sleep-disordered breathing. A relationship between periodontitis and obstructive sleep apnea (OSA) is plausible, but has received little attention. This study investigated the strength of association between periodontitis and risk for OSA.


In this case-control study, cases had moderate or severe periodontitis (n = 50, 32.5%) and controls had gingivitis or slight periodontitis (n = 104, 67.5%). Sixty-one males (39.6%) and 93 females (60.4%) with a mean age of 61 years were sampled from the dental hygiene preventive care clinic in the School of Dentistry at the University of North Carolina at Chapel Hill between February and April 2011. Patients received a full mouth periodontal examination that included probing pocket depths and clinical attachment levels at 6 sites per tooth. The case definition for moderate or severe periodontitis was that of the American Dental Association (ADA). Risk for OSA was determined by the 4 item "STOP" OSA screening questionnaire, which assesses self-reported snoring, excessive daytime sleepiness, witnessed apnea during sleep and history of hypertension. Demographic, general health and orofacial characteristics were recorded that were considered putative predictors of either periodontitis or OSA. A multivariate binary logistic regression assessed odds of moderate or severe periodontitis according to OSA risk with adjustment for potential confounders.


In all, 59 patients (38.3%) screened at high risk for OSA by providing 2 or more affirmative responses on the STOP questionnaire. Sixty percent of periodontitis cases (n = 30) screened high risk of OSA compared with only 28% of controls (n = 29). Cases were 4.1 times more likely (95% CI: 1.9, 11.4) to be at high risk for OSA than controls (p = 0.007) after adjustment for potential confounders.


A significant association was observed between moderate or severe periodontitis and risk for OSA.


STOP questionnaire; epidemiology; human; obstructive sleep apnea; periodontitis

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