Evaluation of an association between long sleep duration and periodontal disease among men and women using nationally representative data

Sleep and periodontal health

Sleep is fundamental for health and well-being. An adequate amount and quality of sleep is a cardinal component of a healthy lifestyle at the basis of the prevention of many non-communicable chronic diseases. Recent evidence suggests that sleep disorders, particularly obstructive sleep apnea, represent an emerging risk factor for periodontal health. This review article provides a critical appraisal of the existing literature concerning the association between sleep duration, sleep quality, sleep disorders in general, and obstructive sleep apnea with periodontal diseases, including gingivitis and periodontitis. The putative mechanisms underlying these associations are described as well as the potential clinical implications for diagnosis and treatment.

No genetic association between sleep traits and periodontitis: A bidirectional two-sample Mendelian randomization study

OBJECTIVE

This study aimed to investigate the potential genetic link between sleep traits and periodontitis.

METHODS

A two-sample bidirectional Mendelian randomization (MR) analysis was conducted using publicly available genome-wide association studies data on chronotype, daytime sleepiness, daytime napping frequency, insomnia, sleep duration, snoring, and the apnea-hypopnea index (AHI), along with a separate dataset on periodontitis.

RESULTS

Chronotype (OR = 0.929, 95% CI = 0.788-1.095), daytime sleepiness (OR = 0.492, 95% CI = 0.186-1.306), daytime napping frequency (OR = 1.178, 95% CI = 0.745-1.863), sleep duration (OR = 0.868, 95% CI = 0.644-1.169), AHI (OR = 1.124, 95% CI = 0.980-1.289), insomnia (OR = 0.832, 95% CI = 0.440-1.573), and snoring (OR = 0.641, 95% CI = 0.198-2.075) had no effect on periodontitis. Similarly, periodontitis demonstrated no significant effect on sleep traits.

CONCLUSIONS

There is no evidence of a bidirectional genetic relationship between sleep traits and the risk of periodontitis.

Sleep Duration and Risk of Periodontitis-A Systematic Review and Meta-Analysis

Periodontitis, with a high prevalence in the whole population, is the main cause of tooth loss. Some studies have revealed that sleep duration may be related to periodontitis, however, the opinions are not consistent. This meta-analysis was carried out to study the potential relationship between sleep duration and periodontitis. A search of relevant articles was conducted on Embase, PubMed, Cochrane Library, and Web of Science. Papers published until the end of November 2022 reporting associations between sleep duration and periodontitis were considered. The pooled odds ratio (OR) with a 95% confidence interval (CI) was calculated to assess the association. Software STATA 14.0 was employed to conduct this analysis. A total of 11 cross-sectional studies were included. Our study showed neither short sleep duration (SSD) nor long sleep duration (LSD) were associated with periodontitis (SSD: OR = 1.04, 95% CI: 0.83, 1.29; LSD: OR = 1.12, 95% CI: 0.94, 1.23), while higher prevalence was observed when sleep duration ≤5 h (OR = 1.41, 95% CI: 1.33, 1.51). In addition, both SSD and LSD were not associated with severe periodontitis (SSD: OR = 0.94, 95% CI: 0.75, 1.16; LSD: OR = 1.19, 95% CI: 0.80, 1.76). In conclusion, the present review indicated that too little sleep duration (≤5 h) significantly increased the risk of periodontitis. However, the evidence is limited due to cross-sectional design of most studies, Hence longitudinal studies should be conducted to support this finding.

The underlying relationship between exercise and the prevalence of periodontitis: a systematic review and meta-analysis

BACKGROUND

Although exercise has been proposed as an effective intervention for various lifestyle-related diseases and pathological scenarios, few researches assessed the impact of taking exercise on the prevalence of periodontitis.

PURPOSE

This study aimed to perform a comprehensive literature review and meta-analysis from both observational and intervention studies to explore the relationship between exercise and periodontitis and to provide references for future intervention programs aimed at preventing periodontitis.

METHOD

A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus for peer-reviewed studies published in English From January 1993 to January 2023 according to the PRISMA guidelines. Articles were selected if subjects were human and studies evaluating the association between exercise and periodontitis.

RESULTS

4098 references were retrieved. After screening the results, 30 studies were selected. Of these, 20 studies indicated an inverse association between exercise and periodontitis, while the remaining 10 did not reach conclusive findings. The meta-analysis demonstrated a risk ratio of 0.84 (95%CI: 0.77, 0.91) between the active group and the inactive group (P < 0.01), which indicated an inverse relationship between exercise and periodontitis.

CONCLUSION

Overall, the increase in exercise presents an inverse association with the presence and severity of periodontitis. Accordingly, taking exercise might be a potential approach that contributes to improvements in periodontitis.

Is insufficient sleep duration a risk indicator for periodontal disease? A systematic review

OBJECTIVES

In this study, we conducted a systematic review and meta-analysis to assess whether people who achieved <7 h of sleep were more likely to develop periodontal disease (PD).

SOURCES

We executed electronic searches in the PubMed, EMBASE and Cochrane Library, as well as a manual search of articles published by leading journals in related fields, for observational studies, published in English from 1 January 1966 to 31 March 2021.which evaluated the relationship between sleep duration and PD. The Agency for Healthcare Research and Quality (AHRQ) quality evaluation scale was used for the cross-sectional studies, and the random effects model was used to summarize the effect sizes in the included studies with a 95% confidence interval (CI).

RESULTS

A total of six cross-sectional studies met the inclusion criteria, totaling 107,777 participants, of which 69,773 had PD. The results of the present indicated that shorter sleep duration (<7 h) is significantly associated with PD (Odd ratio [OR], 1.19; 95% CI, 1.16-1.23; p < 0.001; I² , 0.0%, I² interval, 0%-75%). The strength of the sensitivity analysis and cumulative meta-analysis confirmed the reliability of the results.

CONCLUSION

Although the inclusion of only six studies makes it difficult to explore whether there is a publication bias, we found that insufficient sleep duration was closely related to PD, and we therefore speculated that getting enough sleep may help prevent PD.

Sleep duration and severe periodontitis in middle-aged Japanese workers

AIM

To evaluate the association between sleep duration and severe periodontitis in Japanese workers.

MATERIALS AND METHODS

This cross-sectional study included 1130 workers (mean age 43.0 years) who underwent full-mouth periodontal examinations and health check-ups and completed a self-administered questionnaire that included questions on sleep duration. Logistic regression and a restricted cubic spline model were used to analyse the data.

RESULTS

Severe periodontitis was identified in 6.3% of the study population. Those with <5, 5-5.9, 6-6.9, 7-7.9, and ≥8 hr of sleep were 6.7%, 17.4%, 40.3%, 26.3%, and 8.9%, respectively. After adjusting for potential confounders, study participants who slept <5 hr were more likely to have severe periodontitis (adjusted odds ratio = 2.64; 95% confidence interval = 1.06-6.60) than those who slept 7-7.9 hr. The spline model, with a reference value of 399 min (the median sleep duration), showed a non-linear association between sleep duration and severe periodontitis, where an increased prevalence of severe periodontitis was observed only among those with a shorter sleep duration. The prevalence of severe periodontitis did not increase with longer sleep duration.

CONCLUSIONS

Short sleep duration was associated with severe periodontitis in this cohort of Japanese adults.

Shift work sleep disorder is closely associated with an increased risk for periodontal disease

AIM

This study aimed to investigate the association between work patterns and periodontal disease.

MATERIALS AND METHODS

Data were collected from the Korea National Health and Nutrition Examination Survey between 2007 and 2012, and data from 22,508 subjects aged ≥19 years were included. An individual's work pattern was classified as either daytime or shift work. Sleep duration was categorized into three ranges: ≤5, 6-8, and ≥9 h/day. A multivariate logistic regression model was used to determine the adjusted odds ratio (OR) for CPI (Community Periodontal Index) ≥3. The CONTRAST statement was used to show the interaction effect of work patterns and sleep duration.

RESULTS

The adjusted OR of shift work was 2.168 (CI: 1.929-2.438, p < .0001). Participants who sleep ≤5 or ≥9 h/day showed ORs 0.735 and 0.663, respectively (p = .0181). Interaction effect analysis revealed that the work pattern had a strong influence on periodontal condition when combined with the sleep amount. Shift workers with ≤5 or ≥ 9 h of sleep showed significantly increased ORs for CPI ≥3 (2.1406 and 2.3251, respectively, p < .0001). The ORs for daytime workers were comparable to the original values (≤5: 0.7348, p = .0292; ≥9: 0.6633, p = .0428).

CONCLUSION

Altered sleep patterns caused by shift work have more influence on periodontal disease than sleep duration.

Association of short sleep with risk of periodontal disease: A meta-analysis and Mendelian randomization study

AIM

The aim of this meta-analysis and Mendelian randomization (MR) study was to assess the association between short sleep and periodontal disease, including tooth loss and periodontitis.

MATERIALS AND METHODS

The meta-analysis of relevant studies was conducted to assess the association between short sleep and periodontal disease. MR analyses were conducted with the inverse-variance-weighted (IVW) method, weighted median method, MR-Egger method, and MR-Robust Adjusted Profile Score (RAPS) method to assess the causal effect of short sleep on tooth loss and periodontitis.

RESULTS

Seven cross-sectional studies involving 40,196 individuals were included in the meta-analysis. The association between short sleep and periodontal disease was not statistically significant (odds ratios (OR) =1.13, 95% confidence interval (CI): 0.99, 1.28; p = 0.076). In the MR analysis, we did not observe statistically significant causal associations of genetically determined short sleep with tooth loss (β: -0.056; 95% CI: -0.181 to 0.068; p = 0.376) and periodontitis (β: -0.112; 95% CI: -0.340 to 0.117; p = 0.339).

CONCLUSIONS

Short sleep is not associated with the risk of periodontal disease according to current evidence. Future studies need to pay attention to the measurement of sleep duration, the choice of statistical models, and other domains of sleep health.

Are periodontal diseases associated with sleep duration or sleep quality? A systematic review

OBJECTIVES

This study aimed to systematically review the associations between periodontal diseases/tooth loss and sleep duration/quality.

MATERIAL AND METHODS

PubMed, Scopus, and Embase databases were searched (up to May 2021) to identify studies that assessed the association between periodontal diseases or number of teeth with sleep quality and sleep duration. Two researchers independently selected the studies and extracted the data. Considering the high heterogeneity among the included studies, meta-analysis was deemed unviable. Results are presented descriptively for sleep quality (studies that have used PSQI), self-reported sleep hours, and other tools that assessed sleep patterns.

RESULTS

Twenty studies (16 cross-sectional, two case-control, and two cohort) were included. Eight studies used the Pittsburgh Sleep Quality Index (PSQI) to assess quality of sleep. Six of these studies demonstrated that individuals with worse periodontal conditions demonstrated poorer sleep quality. However, most of the included studies that performed adjusted analysis showed no statistically significant association between self-reported hours of sleep and periodontitis. The mean number of present teeth was assessed in four studies; three of them demonstrated lower numbers of present teeth in individuals with inadequate sleep.

CONCLUSION

The literature shows conflicting results for the association between sleep hours and periodontitis. However, inadequate sleep may be associated with lower number of present teeth and periodontal diseases. Further studies are necessary in order to confirm these results.

Association between toothbrushing and non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is considered the hepatic manifestation of metabolic syndrome. Periodontitis, as chronic inflammatory destructive disease, is associated metabolic syndromes bidirectionally. Toothbrushing is an essential and important way to manage periodontitis through mechanical removal of biofilm at periodontal tissue. We aimed to assess the association between toothbrushing frequency and the prevalent NAFLD in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2010, a total of 6,352 subjects were analyzed. NAFLD was defined as fatty liver index ≥60. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). An inverse association between toothbrushing frequency and NAFLD was found. The adjusted ORs (95% CIs) of NALFD was 0.56 (0.35-0.91) in the group who performed toothbrushing ≥ 3 per day compared to the group that performed toothbrushing ≤ 1 per day. For those with toothbrushing frequency ≤1 per day, the adjusted OR (95% CIs) of NAFLD was 2.26 (1.22-4.19) in smokers and 4.52 (1.97-10.38) in subjects with diabetes mellitus (DM), compared to those without the disease and with toothbrushing frequency ≥2 per day, respectively. Our results indicate that higher frequency of toothbrushing is inversely associated with NAFLD. As a modifiable oral habit, regular toothbrushing may be recommended to lower risk of NAFLD, especially in high risk groups such as smokers and diabetic patients.

Sleep time and duration is associated with periodontitis in a representative sample of Koreans

BACKGROUND

So far, studies on the association between sleep and periodontitis have shown conflicting results. This study assessed the association among sleep duration, sleep time, and periodontitis among a nationally representative Korean population and the mediation effect of WBC.

METHODS

We analyzed data from the Seventh Korean National Health and Nutrition Examination Survey (KNHANES VII) collected from 2016 to 2018. With the screenings by age (45 to 64), edentate, and the adequacy of information provided, the analysis was confined to a selected group of respondents of 4407 with measurements for the sleep survey and periodontal health status out of total 24,269. Periodontitis was defined according to the World Health Organization's community periodontal index (CPI) code greater than or equal to three, and severe periodontitis was defined as CPI code 4. Multivariable logistic regression analysis was used to test the association between sleep and periodontitis controlling the confounding factors.

RESULTS

Those who went to bed during the daytime were associated with periodontitis (OR = 1.49, 95% confidence interval [CI]: 1.07 to 2.07). In a combined sleep time and duration model, those who went to bed at night with a sleep duration of 9 hours or more were associated with periodontitis (OR = 1.69, 95% CI: 1.04 to 2.77) and severe periodontitis (OR = 1.88, 95% CI: 1.02-3.45). WBC count had the highest impact on the association between sleep time and periodontitis.

CONCLUSIONS

Our findings suggest that an extra-long sleep duration and going to bed during the daytime are associated with periodontitis.

Is inadequate sleep a potential risk factor for periodontitis?

This study was undertaken to investigate the potential association between sleep duration and periodontitis. The study population consisted of 10,291 individuals who participated in the United States National Health and Nutrition Examination Survey (NHANES) from the 2009–2014 cycles. Sleep duration was categorized into sleep deficient (< 7 hours), sleep adequate (7–8 hours), and sleep excessive (> 8 hours). We used the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) periodontitis case definition. Descriptive statistics and logistic regression models were used for data analyses. The prevalence of periodontitis was 36% higher in individuals who reported sleep deficiency when compared to the sleep adequate group (odds Ratio (OR) = 1.36, 95% confidence interval (CI): 1.23–1.50). Those who reported excessive sleep had 41% higher odds of periodontitis (OR: 1.40, 95% CI: 1.16–1.71). After adjusting for confounding factors, sleep deficient individuals were 19% more likely to have periodontitis when compared to sleep adequate individuals (OR: 1.19, 95% CI: 1.06–1.38). Among sleep excessive individuals, the association was non-significant (OR: 1.16, 95% CI: 0.94–1.43). Sleep deficiency was associated with a higher prevalence of periodontitis in this study population. The association however needs to be confirmed in longitudinal studies.

Association between Fatty Liver Index and Periodontitis: the Korea National Health and Nutrition Examination Survey

It has been suggested that periodontitis is associated with metabolic abnormalities including non-alcoholic fatty liver disease (NAFLD). The fatty liver index (FLI) is a non-invasive surrogate marker and predictor of NAFLD. We aimed to determine whether FLI itself would be associated with periodontitis through a secondary analysis of previously reported nationally representative probability sample data of the Korean population. FLI was calculated from a previously developed algorithm which combines measures of body mass index (BMI), waist circumference, triglyceride, and gamma-glutamyl transferase (GGT). Periodontitis was diagnosed based on the Community Periodontal Index (CPI) developed by the World Health Organization. Of 4,272 participants, 26.1% were diagnosed with periodontitis. Higher FLI was associated with a higher prevalence of periodontitis (Odds ratio (OR) _{highest vs. lowest quartile of FLI},1.63; 95% confidence interval (CI), 1.23–2.16; P = 0.001 for trend) adjusting for confounding factors. In the highest FLI quartile, prevalence of periodontitis was higher in individuals with diabetes (OR _{highest vs. lowest quartile of FLI}, 2.89; 95% CI, 1.01–8.27 for diabetic subgroup; OR _{highest vs. lowest quartile of FLI}, 1.45; 95% CI, 1.07–1.96 for non-diabetic subgroup). In summary, FLI was associated with prevalent periodontitis.