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

Sleep. 2015 Aug 1;38(8):1195-203. doi: 10.5665/sleep.4890.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • C-Reactive Protein / analysis
  • Cross-Sectional Studies
  • Female
  • Health Surveys*
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Periodontitis / complications*
  • Periodontitis / diagnosis
  • Periodontitis / metabolism
  • Regression Analysis
  • Residence Characteristics
  • Risk Factors
  • Sleep
  • Sleep Apnea Syndromes / complications*
  • Sleep Apnea Syndromes / diagnosis
  • Sleep Apnea Syndromes / metabolism
  • Sleep Apnea Syndromes / physiopathology
  • United States
  • Young Adult


  • C-Reactive Protein