An Update on the Association Between Periodontitis and Obstructive Sleep Apnea

The aim of this systematic review and meta-analysis was to update evidence answering four questions: (1) Is there an association between periodontitis and obstructive sleep apnea (OSA)? (2) Is there evidence of causality? (3) Is there a dose-response relationship between the two conditions? (4) Is there evidence on efficacy of periodontitis interventions on the occurrence and/or severity of OSA or vice versa? Thirteen studies were included in the qualitative analysis, and nine of them were included in the quantitative analysis. Seven studies were case-control and six were cross-sectional. All studies assessed the association between periodontitis and OSA, five studies evaluated the dose-response relation, and one examined the efficacy of periodontal interventions on OSA occurrence. There is a significant positive association between periodontitis and OSA (adjusted OR = 1.66, 95% CI,1.28, 2.17; P = 0.0002). Evidence on a dose-response gradient was conflicting. Evidence was insufficient and non-existent for efficacy of interventions and causality, respectively. There is mounting evidence that supports an association between periodontitis and OSA. However, future studies are warranted to determine does-response relation, causality, and reversibility.