Obstructive sleep apnea and periodontitis: a cross-sectional study of shared risk factors and cytokine concentrations

Abstract

Background: Obstructive sleep apnea (OSA) and periodontitis share several risk factors, including systemic diseases, inflammation, and plaque accumulation from mouth-breathing. The relationship and its potential mechanisms are still poorly understood. Whereas prior research has predominantly examined the periodontitis-OSA association beginning with an OSA diagnosis, this present study investigates this relationship starting with a periodontal diagnosis. Aim: This cross-sectional study was performed to investigate the association between periodontitis and OSA, and potential risk factors including pro-inflammatory cytokines. Methods: Forty patients (21 periodontitis patients with generalized Stage III Grade B or C; 19 non-periodontitis patients with clinical gingival health on an intact or reduced periodontium) were included in this study. Full periodontal exam assessed plaque index, bleeding on probing, probing depths, and clinical attachment loss. Obstructive sleep apnea was diagnosed using an overnight Level 3 home sleep apnea test. Gingival crevicular fluid (GCF) samples were collected for cytokine analysis. Results: Periodontitis was not significantly associated with OSA. However, both periodontitis and OSA demonstrated a significant increase in Interleukin-1β (IL-1β), suggesting shared inflammatory pathways. Plaque score was significantly higher in OSA patients and significantly associated with body mass index (BMI) >25. Conclusion: The relationship between periodontitis and OSA may be mediated by systemic inflammation, plaque accumulation via mouth-breathing, and shared risk factors (e.g. high BMI), which can also contribute to the increased systemic inflammatory burden. Considerations for periodontal care should include the oral-systemic link and related systemic conditions such as OSA for reducing the overall inflammatory load and improving patient outcomes and overall health.