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

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.

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.

Association of Sleep Duration with Tooth Loss and Periodontitis: Insights from the National Health and Nutrition Examination Surveys (2005-2020)

OBJECTIVE

Sleep disorders such as insomnia, apnea, and restless leg syndrome can negatively affect a person's overall health and may cause hypertension, heart failure, and coronary heart disease. Likewise, periodontitis, a gum disease, can lead to both physical and psychological health issues, exerting a considerable effect on one's overall well-being-periodontitis stands as a primary cause of tooth loss. Nevertheless, there has been insufficient research on the correlation between the amount of sleep individuals get and the occurrence of periodontitis/tooth loss among Americans. Therefore, this study aimed to assess the influence of sleep length on periodontitis in the American population.

METHODS

Periodontitis severity was classified (none, mild, moderate, and severe) using American Periodontal Association criteria. Sleep duration was assessed by self-reported data and categorized into three groups (deficient, adequate, and excessive). Tooth loss was assessed by the oral examination. To establish a connection between the duration of sleep and periodontitis/tooth loss, a weighted multivariable logistic regression analysis was employed. A GAM analysis and smooth curve fitting assessment were conducted to identify non-linear relationships. Subgroup, interaction, and mediation analyses were also performed.

RESULTS

The prevalence of tooth loss was significantly high, affecting 96.4% of the individuals, whereas 46.6% of the study sample experienced moderate to severe periodontitis. The average age of participants was 52.7 years. After adjusting for potential confounding factors, the analysis of weighted multivariable logistic regression revealed a significant association between sleep insufficiency and moderate/severe periodontitis (OR 1.15, 95% CI 1.01-1.30, P = 0.0298), as well as tooth loss (OR 1.16, 95% CI 1.01-1.33, P = 0.0371). Additionally, the research showed a correlation between the length of sleep and periodontitis that followed a U-shaped pattern. In addition, the analysis of mediation revealed that high blood pressure explained 7.0% (95% CI 4.0% to 12.9%; P < 0.0001) of the link between the amount of sleep and the likelihood of losing teeth.

CONCLUSION

Sleep duration was independently correlated with moderate/severe periodontitis/tooth loss and had a non-linear relationship.

Shift work promotes adipogenesis via cortisol-dependent downregulation of EGR3-HDAC6 pathway

The disruption of circadian rhythms caused by long-term shift work can cause metabolic diseases such as obesity. Early growth response 3 (EGR3) is a member of early growth response (EGR) family, which is involved in several cellular responses, had been reported as a circadian rhythm gene in suprachiasmatic nucleus. In this research, EGR3 was found to be widely expressed in the different tissue of human and mice, and downregulated in adipose tissue of obese subjects and high-fat diet mice. Moreover, EGR3 was found negatively regulated by cortisol. In addition, EGR3 is a key negative modulator of hADSCs and 3T3-L1 adipogenesis via regulating HDAC6, which is a downstream target gene of EGR3 and a negative regulator of adipogenesis and lipogenesis. These findings may explain how circadian rhythm disorder induced by shift works can cause obesity. Our study revealed a potential therapeutic target to alleviate metabolic disorders in shift workers and may provide better health guidance to shift workers.

Influence of shift work on periodontitis according to the occupation group

This study aimed to investigate the effects of shift work on periodontal disease in blue-and white-collar workers and to examine the interaction effects between occupation and work patterns. Data were collected from the Korea National Health and Nutrition Examination Survey conducted by the Korean Ministry of Health and Welfare for a total of nine years from 2007 to 2015. Participants with missing outcome variables were excluded from the analysis and a total of 32,336 participants were included in the final analysis. Univariable odds ratios (OR) were calculated using a logistic regression model with 95% confidence interval (CI). A multivariable logistic regression analysis was performed using the backward elimination method. The CONTRAST statement was used to analyze the interaction effect between occupation and work patterns. Multivariable logistic regression analysis revealed that interaction effects are present between the terms, occupational type and work pattern. Crude OR of shift work for periodontitis was 1.269 [CI 1.213-1.327, P < 0.05]. However, following adjustment for multiple confounding factors and the interaction effect term considered, this OR (1.269) increased to 1.381 [CI 1.253-1.523] in white-collar group while it decreased to 1.198 [1.119-1.283] in blue-collar. Crude OR of blue-collar (OR = 3.123, CI 2.972-3.281, P < 0.05) decreased to 1.151 [CI 1.049-1.262] when interaction effect to the shift work was considered. Shift work pattern increases the risk for periodontitis and this adverse effect is greater when white-collar workers are engaged comparing to blue-collar. The result of this study suggests that 24/7 lifestyle of the modern society poses health risks to the relevant people and the potential harm can be greater to white-collar workers.

Implications of sleep disorders for periodontitis

PURPOSE

Periodontitis is a chronic inflammatory disease caused by multi-factors. Sleep is a natural physiologic process, and the sleep duration, quality, and patterns might be associated with periodontitis. Meanwhile, periodontitis might in turn induce systemic inflammation and thus impact sleep in different ways as well.

METHODS

To investigate the bidirectional relationship between sleep disorder and periodontitis, a literature search was conducted to reveal the interaction and possible mechanism between these two diseases.

RESULTS

The results show that sleep disorders can affect the progression of periodontitis via some pathomechanisms, and periodontitis also has a reverse impact on sleep.

CONCLUSION

Although the epidemiologic and clinical trials found the possible associations between sleep disorder and periodontitis, their relationship is still not that explicit. Further studies are warranted to shed light on them, to improve preventive health care.

DNER and GNL2 are differentially m6A methylated in periodontitis in comparison with periodontal health revealed by m6A microarray of human gingival tissue and transcriptomic analysis

OBJECTIVE

This study aims to investigate the differences in the epigenomic patterns of N6-methyladenosine (m6A) methylation in gingival tissues between patients with periodontitis (PD) and healthy controls, identifying potential biomarkers.

BACKGROUND

As a multifactorial disease, PD involves multiple genetic and environmental effects. The m6A modification is the most prevalent internal mRNA modification and linked to various inflammatory diseases. However, the m6A modification pattern and m6A-related signatures in PD remain unclear.

MATERIALS AND METHODS

An m6A microarray of human gingival tissues was conducted in eight subjects: four diagnosed with PD and four healthy controls. Microarray analysis was performed to identify the differentially m6A methylated mRNAs (DMGs) and the differentially expressed mRNAs (DEGs). The differentially methylated and expressed mRNAs (DMEGs) were subjected to functional enrichment analysis by Metascape. The weighted gene co-expression network analysis (WGCNA) algorithm, the least absolute shrinkage and selection operator (LASSO) regression, and univariate logistic regression were performed to identify potential biomarkers. The cell type localization of the target genes was determined using single-cell RNA-seq (scRNA-seq) analysis. The m6A methylation level and gene expression of hub genes were subsequently verified by m6A methylated RNA immunoprecipitation (MeRIP) and quantitative real-time PCR (qRT-PCR).

RESULTS

In total, 458 DMGs, 750 DEGs, and 279 DMEGs were identified based on our microarray. Pathway analyses conducted for the DMEGs revealed that biological functions were mainly involved in the regulation of stem cell differentiation, ossification, circadian rhythm, and insulin secretion pathways. Besides, the genes involved in crucial biological processes were mainly expressed in fibroblast and epithelial cells. Furthermore, the m6A methylation and expression levels of two hub biomarkers (DNER and GNL2) were validated.

CONCLUSION

The current study exhibited a distinct m6A epitranscriptome, identified and verified two PD-related biomarkers (DNER and GNL2), which may provide novel insights into revealing the new molecular mechanisms and latent targets of PD.

Circadian rhythm disruption exacerbates the progression of macrophage dysfunction and alveolar bone loss in periodontitis

Macrophages are highly implicated in the progression of periodontitis, while circadian rhythm disruption (CRD) promotes the inflammatory response of macrophages in many diseases. However, the effects of CRD on periodontitis and the role of macrophages in this process remain unclear. Histone lysinedemethylase6a (Kdm6a), a histone demethylase, has recently been identified as a key regulator of macrophage-induced inflammation. Here, we established an experimental periodontitis model by injecting lipopolysaccharide (LPS) derived from Porphyromonas gingivalis with or without periodontal ligation in mice exposed to an 8-h time shift jet-lag schedule every 3 days. By histomorphometry, tartrate acid phosphatase (TRAP) staining, RT-qPCR, ELISA, immunohistochemistry and immunofluorescence analysis, we found that CRD promoted the inflammatory response, alveolar bone resorption, macrophage infiltration and Kdm6a expression in macrophages. Macrophage-specific Kdm6a knockout mice were further used to elucidate the effects of Kdm6a deficiency on periodontitis. Kdm6a deletion in macrophages rescued periodontal tissue inflammation, osteoclastogenesis, and alveolar bone loss in a mouse model of periodontitis. These findings suggest that CRD may intensify periodontitis by increasing the infiltration and activation of macrophages. Kdm6a promotes the inflammatory response in macrophages, which may participate in aggravated periodontitis via CRD.

Prevalence and Influencing Factors of Irritable Bowel Syndrome in Medical Staff: A Meta-Analysis

BACKGROUND

Irritable bowel syndrome (IBS) is a common functional digestive tract disease worldwide, with a high prevalence among medical staff. The purpose of this study is to systematically evaluate the prevalence and influencing factors of IBS in medical staff.

METHODS

We searched English online databases, including PubMed, The Cochrane Library, Web of Science, Embase, and EBSCOhost. The retrieval time was from database establishment to May of 2021. We screened the literature according to inclusion and exclusion criteria, extracted the relevant information, and evaluated the research quality. A meta-analysis was performed using the Stata 16.0 and Review Manager 5.4.1 software.

RESULTS

A total of 11 English studies from seven countries were included in this study, including 3,360 medical staff. The results of the meta-analysis showed an overall prevalence of IBS among medical staff of 16% [95%CI (0.15 ~ 0.17)] and that shift work (OR 2.27)), poor sleep quality (OR 4.27), and female gender (OR 2.29) are the major influencing factors of medical staff suffering from IBS.

CONCLUSIONS

The prevalence of irritable bowel syndrome among medical staff is relatively high, and hospitals can start by looking for targeted interventions from the highly related factors of IBS among medical staff such as shift work patterns, females, and poor sleep quality.

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.