Non-Apnea Sleep Disorder Increases the Risk of Periodontal Disease: A Retrospective Population-Based Cohort Study

• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 4, 2014, págs. 65-71
• Idioma: inglés
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• Resumen

  • Background: The aim of this study is to determine whether patients with a non-apnea sleep disorder (NA-SD) and comorbidity have an increased risk of periodontal disease.

    Methods: Patients newly diagnosed with NA-SDs in 1997 to 2010 were identified as the study cohort from the Taiwan National Health Insurance database. For each patient with NA-SD, two matched controls without sleep disorders were randomly selected for comparison.

    Results: The overall incidence rate ratio of severe periodontal diseases was 39% higher in the NA-SD cohort than in the comparison cohort (7.93 versus 5.69 per 1,000 person-years), with an adjusted hazard ratio (HR) of 1.36 (95% confidence interval [CI]: 1.30 to 1.43). The effect of NA-SD on the risk of severe periodontal diseases was higher in young and middle-aged patients compared with patients >65 years of age (<35 years of age, HR: 1.13, 95% CI: 1.04 to 1.24; 35 to 49 years of age, HR: 1.73, 95% CI: 1.61 to 1.86; 50 to 64 years of age, HR: 1.69, 95% CI: 1.58 to 1.81; =65, HR: [reference] 1.0).

    Conclusion: NA-SD might increase the risk of periodontal disease.

    Periodontal disease refers to the destructive inflammatory reaction of the surrounding tissues of the tooth such as the periodontal ligaments, cementum, alveolar bone, and gingival tissues. As the disease progresses, the inflammatory lesion of periodontitis results in deep gingival pocket development and eventually bone breakdown, tooth loosening, and tooth loss. These diseases are prevalent and can affect up to 90% of the worldwide population,1 including �91% of adults in Taiwan.2 The main risk factors of periodontal disease are associated with poor oral hygiene, presence of oral plaque microorganisms, genetics, tobacco and alcohol consumption, poor nutrition, stress, and impaired host immune responses.1 Some systemic diseases,3-5 such as diabetes mellitus,6,7 cardiovascular diseases,8,9 hematologic diseases,10 and psychosomatic diseases,11,12 might play an important role in periodontal diseases. The possible pathogenesis of periodontitis is an immune-inflammatory response induced by the presence of plaque bacteria developing in the periodontal tissue. The sustained inflammatory mediators and host cellular components release proteolytic enzymes that damage soft and hard tissues.13 Sleep disorders have affected �4 to 6 million people in Taiwan according to a survey by the Taiwan Society of Sleep Medicine.14 It is well known that sleep is a critical factor for maintaining mental and physical health. Sleep deprivation threatens a person�s health. The major effects of sleep deprivation include physical effects, such as sleepiness, chronic fatigue syndrome, hypertension, cognitive disorders (e.g., deterioration of attention and motivation, diminishment of mental concentration and intellectual capacity, and an increase of the risk of accidents during working and driving), and mental health problems.15 Sleep disorders impair the ability to think, manage stress, and maintain a healthy immune system and emotions. Complete sleep deprivation is fatal in an animal study model.16 Previous studies have shown the association between the immune system and sleep disorders.17-19 The mechanisms by which sleep disorders affect health are unclear, but some studies have suggested that altered sleep might influence the cytokine level, e.g., C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), interleukin (IL)-6, which regulates inflammatory reactions.19-21 These studies have implicated sleep disorders as an etiologic factor of periodontal disease. Based on the authors� research, no large population-based studies have outlined the relationship between periodontal diseases and sleep disorders in Taiwan. In this study, therefore, the authors investigate whether non-apnea sleep disorder (NA-SD) (excluding apnea sleep disorder or named obstructive sleep apnea disorder) increases the risk of periodontal disease. The original database was derived from the Taiwan National Health Insurance (TNHI) system. The results presented in this paper were derived from a retrospective cohort study to assess the possibility of a lower risk of periodontal diseases with management of NA-SD by clinicians.