Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos

Abstract

Study objectives: To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis.

Design: Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos.

Setting: Community-based setting with probability sampling from four urban US communities.

Participants: 12,469 adults aged 18-74 y.

Interventions: None.

Measurements and results: Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1-4.9 (subclinical); 5.0-14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis.

Conclusions: This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults.

Keywords: Hispanic; apnea-hypopnea index; epidemiology; periodontal disease; survey.

Figure 1

Relationship of sleep disordered breathing (SDB) severity, assessed by the apnea-hypopnea index and chronic severe periodontitis (n = 12,469). Estimates are expressed at specified ages of 20, 25, 30, 35, 40, 45, 50, 55, and 60 y, stratified at severity thresholds. Predicted estimates were obtained from a binary logistic regression model that adjusted for age, sex, and heritage, number of retained teeth, smoking, diabetes, body mass index, and high-sensitivity C-reactive protein. Findings show a monotonic relationship of greater probability of severe periodontitis at greater SDB severity. There is an effect modification of age (P < 0.001) such that SDB has a stronger relationship with severe periodontitis in younger adults and that this relationship weakens at older ages. AHI, apnea-hypopnea index; CI, confidence interval.