LINK BETWEEN OBSTRUCTIVE SLEEP APNEA WITH PERIODONTITIS

Subash L

    INTRODUCTION 

    Obstructive sleep apnoea (OSA) is a highly prevalent disorder affecting between 10–50% of middle-aged men. 

    OSA is characterized by recurrent upper airway obstruction associated with cyclic changes in oxyhemoglobin saturation, intermittent arousals from sleep and alterations in intrathoracic pressure. 

    Photo credit: https://melbentgroup.com.au/obstructive-sleep-apnea-part-1/


    These alterations induce aerobic stress, sympathetic activation, and metabolic dysregulation. 

    OSA is presently diagnosed with associate nightlong sleep diagnostic assay referred to as a poly-somnogram (PSG), that remains the gold commonplace of diagnosis.

    The quality definition of associate symptom event includes a minimum 10-second interval between breaths, with a neurological arousal, a blood oxygen desaturation of 3% to 4% or larger, or each arousal and desaturation. 

    Prolonged SF is additionally concerned in vascular changes the same as the improved coronary artery disease and vas morbidities related to OSA.

    In children experiencing OSA, elevated systemic levels of lipopolysaccharide (LPS)-binding protein, a surrogate marker of underlying low-grade LPS endotoxemia from the gut, were independently associated with BMI and with measures of OSA severity, as well as with established measures of insulin resistance. 

    Photo credit: https://www.researchgate.net/figure/Model-of-association-between-obesity-and-periodontal-disease-through-inflammation_fig2_320484423 [accessed 29 May, 2020]


    Periodontal disease is a chronic inflammatory disease and its prevalence increases with age. Risk factors for periodontal disease are age, smoking, obesity and various other socioeconomic factors.

    Recently it has been proved that periodontal diseases have relationship with various systemic diseases like diabetes, coronary disease, osteoporosis and low birth weight deliveries. Obstructive sleep apnoea is another one of these conditions associated with an inflammatory response.

     

    Relationship between periodontal disease and sleep apnea syndrome. SAS(sleep apnea syndrome) acts as an aggravating risk factor of periodontal disease. Periodontal disease as life-related disease can aggravate a series of life-related diseases 

    Photo credit:https://sites.google.com/site/sleepapneasyndrome/home/clinical-aspects-of-sleep-apnea-syndrome/future-directions/periodontal-disease-and-sas


    DIAGNOSIS OF SLEEP APNEA THROUGH ORAL CAVITY

    Photo credit: https://www.alaskasleep.com/blog/your-dental-health-and-its-connection-to-sleep-apnea 


    Once an individual has been diagnosed with an oral health issue that interrupts proper sleeping habits to place ourself at higher risk for health problems such as:

    • Memory or cognitive functioning
    • Metabolic rate
    • Diabetes
    • High blood pressure
    • Focusing
    • Anxiety
    • Heart Disease
    • Productivity

    Anxiety and stress leads to canker sores which leads to uncomfortable sleeping conditions. By controlling and managing stress, you minimize the risk of cavities providing healthy teeth and gums. 

    Periodontal disease is an infection of the tissues that hold your teeth in place. When an individual is prone to sleep apnea or other sleepless conditions, it increases the chance of dry mouth which builds the tartar on our teeth


    CORRELATION BETWEEN SLEEP APNEA AND PERIODONTITIS 

    • Obstructive sleep apnea has many unwanted side effects.
    •  From general malaise to increased blood pressure, sleep apnea can take a big toll on a person’s well being. 
    • Adding further insult to injury, sleep apnea increases the risk for gum disease. 
    • This is due to a few factors. 
      • First, repeated episodes of apnea followed by resumed breathing tend to make people breathe more through their mouths than their noses while sleeping. Breathing through your mouth will have a drying effect on soft oral tissue. Healthy gums need moisture. When the gums become dry, they become irritated, thus making them more susceptible to inflammation and infection. 
      • Secondly, sleep deprivation caused by sleep apnea will weaken the immune system. A weakened immune system has trouble fighting infection, including the infection associated with gum disease.

    RELATIONSHIP BETWEEN SLEEP APNOEA AND PRO-INFLAMMATORY CYTOKINES 

    Periodontitis has received increasing attention because it may have systemic effects, including infective endocarditis, coronary heart disease, diabetes mellitus, respiratory diseases, osteonecrosis and even malignancy.

    Interleukin (IL)-1b and IL-33 are associated with both acute and chronic inflammation.

    Increased levels of IL-1b were detected in saliva, gingival tissue, and gingival crevicular fluid (GCF) of patients with periodontitis. 

    The prominent biologic effect of IL-33 is the induction of T-helper 2 cytokines and it also possesses anti-inflammatory activity. 

    Pro-inflammatory cytokines are also up-regulated in patients with Obstructive Sleep Apnoea (OSA).
    significant elevations in serum levels of tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), and interleukin 6 (IL-6) have been seen in patients with obstructive sleep apnoea. 

    The recent meta-analysis (MA) showed that there is an increase in levels of inflammatory markers in subjects with OSA including CRP, TNF α, IL-6, IL-8, ICAM, VCAM and Selectins. This effect is positively influenced by severity of OSA

    Photo credit: https://www.mdpi.com/ijms/ijms-20-00459/article_deploy/html/images/ijms-20-00459-g001.png 


    TREATMENT

    Dental and sleep apnea devices accessible incorporate Continuous Positive Airway Pressure machine (CPAP), mouth apparatuses, and uniquely structured pads. 

    Oral medicines incorporate a Mandibular Repositioning device and a Tongue Retaining device. 

    These devices open your aviation route by presenting your lower jaw during rest. They are acrylic and fit inside your mouth, much like an athletic mouth guard. 

    Others may fit around your head and jawline to change the situation of your lower jaw too

    Photo credit: https://www.intechopen.com/books/noninvasive-ventilation-in-medicine-recent-updates/obstructive-sleep-apnea-a-pathophysiology-and-pharmacotherapy-approach


    Photo credit: http://www.kcsleepapneadentist.com/product.html 


    Photo credit: https://www.researchgate.net/figure/Treatment-modalities-for-OSA_tbl1_265691370 [accessed 29 May, 2020] 


    ADVANTAGES OF ORAL APPLIANCES 

    Oral appliances ar simply moveable and convenient

    Oral appliances are ideal for patients World Health Organization don't seem to be smart candidates or like a less invasive approach than surgery

    Oral appliances ar additional discreet and fewer cumbersome than CPAP machines

    Oral appliances can be employed in combination with alternative your CPAP often commutation a strap

    Oral appliances ar custom-designed by your medical man for the patient's mouth and individual desires of use

    Oral appliances are simple to wear and comfy

    Photo credit: https://www.midlandparkfamilydentistry.com/oral-appliance-therapy-and-sleep-apnea/ 


    COMPLICATIONS OF OSA

    Several risk factors are known within the development of OSA particularly male gender(up to age 65), increasing age, menopause, overweight, truncal obesity mirrored by many markers together with BMI, neck circumference, and waist-to-hip quantitative relation, craniofacial abnormalities, higher airway anatomy, smoking, alcohol, and genetic predisposition.

    Obesity is taken into account because the most significant clinical risk issue for the event of OSA. many studies have shown that over half the prevalence of OSA is as a result of excess weight as critical substantial improvement with weight reduction

    Fat Deposition round the pharyngeal airway and abdomen could seemingly to scale back residual capability perform, which might be foreseen to scale back respiratory organ volume tethering effects on the higher airway .

    This latter mechanism emphasizes the good importance of central obesity as compared with peripheral obesity since it's the abdomen way more than the thighs that have an effect on upper-airway size.

    Therefore, obesity has been related to practical impairment in upper airway muscles

    Photo credit: https://www.intechopen.com/books/noninvasive-ventilation-in-medicine-recent-updates/obstructive-sleep-apnea-a-pathophysiology-and-pharmacotherapy-approach


    CONCLUSION

    There seems to be some proof indicating higher levels of markers of general inflammation in patients with disease is related to clogging Sleep Apnoea.

    Still this association is in terribly preliminary stage and additional studies square measure required to explore the role of those markers on the progression of obstructive Sleep Apnoea each from the analysis and clinical perspective.

    Periodontitis could be a antecedently unrecognized however extremely current and clinically relevant malady related to OSA. disease adversely impacts vessel health, promoting coronary-artery disease, that is additionally extremely related to OSA.

    The consequences of disease, particularly tooth loss, could limit OSA medical care selections. Sleep and dental health disparities could worsen the burden of CV disease among low SES groups

    REFERENCE

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