Is periodontitis associated with obstructive sleep apnea? A systematic review and meta-analysis

BACKGROUND: There are conflicting results on the association between periodontitis and obstructive sleep apnea (OSA). In the present study, we performed a contemporaneous systematic review and meta-analysis to clarify this issue. We also tried to find out whether periodontitis is associated with OSA severity. MATERIAL AND METHODS: We searched the literature published from the inception to 31 December 2021 from the databases of Embase, PubMed, Scopus, and Web of Science, using a combination of suitable keywords, without language restriction. We included observational studies recruiting adults (≥18 years old) that evaluated the association between periodontitis and OSA. Two investigators screened independently the titles and abstracts of the identified articles for potential suitability. We compared the prevalence of periodontitis between OSA-positive and negative individuals using a pooled odds ratio (OR) with a 95% confidence interval (CI). The heterogeneity between the studies was examined by the I2 statistic. RESULTS: Of 265 citations, a total of 10 eligible studies containing 30,994 participants were finally included. Analysis of these studies showed that there was a significant association between periodontitis and OSA (OR=2.17, 95% CI: 1.66-2.83), with no significant heterogeneity between the studies (I2=42.7%, p=0.073). Analysis of three surveys indicated that periodontitis is significantly associated with mild-to-moderate OSA (OR=2.51, 95% CI: 1.32-4.78; I2=0.0%, p=0.527), but not with severe OSA (OR=1.58, 95% CI: 0.70-3.58; I2=0.0%, p=0.469). CONCLUSIONS: According to the results, periodontitis has a direct association with OSA. Also, periodontitis has been shown to be associated with mild-to-moderate OSA, but not with severe OSA. Further studies are warranted to elucidate the mechanisms of these associations. Key words:Periodontitis, obstructive sleep apnea, systematic review.