Avaliação da apneia do sono em indivíduos edêntulos

Abstract

Introduction: Obstructive sleep apnea (OSA) is a heterogeneous disorder whose pathogenesis involves risk factors such as genetics, sex, obesity, aging, and craniofacial alterations. Edentulous arches can cause changes in the morphology of the upper airways (UA), reducing the retropharyngeal space and affecting the tone and size of the pharyngeal muscles, which can impact breathing. Objectives: To evaluate the association between obstructive sleep apnea and edentulism, to investigate the relationship between the number of functional posterior occlusal pairs and missing teeth and the severity of OSA, and to characterize the craniofacial anthropometric, dental loss, and polysomnographic profile of the sample. Methods: This is a cross-sectional study comprising adults ≥ 18 years old, of both sexes, diagnosed with OSA using type 1 polysomnography (PSG), and who agreed to participate in the study. The following were not included: individuals with a disease or condition that could prevent PSG from being performed; those with previous treatment for sleep-disordered breathing; those with a previous history of malignant tumors in the upper airways; and pregnant women. Laboratory PSG was used to determine the apnea-hypopnea index (AHI) and the oxyhemoglobin desaturation index (ODI). The Epworth Sleepiness Scale (ESS), Berlin Questionnaire, body mass index, cervical and abdominal circumferences, craniofacial anthropometric measurements, and assessment of dental elements (DEs) and functional posterior occlusal pairs (POPs) were used. Results: A total of 196 patients with OSA were selected, of whom 54 had an AHI≥ 5 ev/h, 56 had an AHI≥ 15 ev/h, and 86 had an AHI≥ 30 ev/h. There were 123 women (62.8%) and 73 men (37.2%), with a median age of 57.0 (15.2). The significant variables were: craniofacial — nasion-gnathion height (p<0.0289) and bizygomatic width (p<0.0002); dentition group — complete dentition, partial edentulous, and total edentulous in 1 or 2 arches (p<0.0303); and POPs [3-5], [6-11], [12] (p<0.0296). In multivariate logistic regression, the variables sex (odds ratio [OR] 0.306, p<0.0180), ESS (OR 1.078, p<0.0390), and ODI (OR 1.177, p<0.0000) were predictors for AHI≥ 15 ev/h; in the controlled model for men, ODI (OR 1.274, p<0.0410); and in the controlled model for women, age (OR 1.069, p<0.0170), abdominal circumference (OR 1.050, p<0.0440), and ODI (OR 1.138, p<0.0020). Correspondence analysis showed that the profile of the individuals studied with AHI≥ 15 ev/h was characterized by cranial index ≥80, missing DEs≥ 12, Sanders et al. classification ≥5 missing DEs, ODI≥ 15 ev/h and mean oxyhemoglobin saturation <90%. Conclusion: There is an association between missing teeth and OSA, which was better evidenced by evaluating the contacts of the posterior teeth by the number of POPs. The position of the missing teeth in the arch is more relevant to assessing the impact of the association with OSA than the number of missing DEs. Craniofacial anthropometric variables and missing teeth were not predictors of AHI≥ 15 ev/h. The profile of the individuals studied with moderate to severe obstructive sleep apnea showed brachycephaly, a more significant number of missing dental elements, and a higher ODI than those with mild apnea, with a mean oxyhemoglobin saturation below 90%.