Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial

Elham Emami, Gilles Lavigne, Jocelyne S Feine, Igor Karp, Pierre H Rompré, Fernanda R Almeida, Nelly T Huynh, Elham Emami, Gilles Lavigne, Jocelyne S Feine, Igor Karp, Pierre H Rompré, Fernanda R Almeida, Nelly T Huynh

Abstract

Study objectives: This study aims to assess whether the nocturnal wear of dentures has an effect on the quality of sleep and oral-health-related quality of life of the edentulous elderly with untreated sleep apnea.

Methods: A single-blind randomized cross-over design with two sequences and two periods was used. Participants (n = 77) were randomly assigned either to sequence 1 (nocturnal wear followed by nocturnal nonwear of the denture for 30-30 days) or sequence 2 (nocturnal nonwear followed by nocturnal wear of denture for 30-30 days). The primary sleep outcome was the quality of sleep, assessed through sleep fragmentation measured as Apnea-Hypopnea Index (AHI) and respiratory arousal from portable polysomnography. Secondary outcomes were daytime sleepiness, sleep quality (Pittsburgh Sleep Quality Index, PSQI) and oral-health-related quality of life measured by validated questionnaires.

Results: The mean paired difference in AHI scores for the period of wearing versus not wearing dentures at night was small 1.0 event per hour (p = 0.50; 95% confidence interval (CI) = -2.0 to 4.1). The mean respiratory arousal index was higher when wearing dentures at night than when not wearing dentures at night, with a mean paired difference of 2.3 events per hour (p = 0.05; 95% CI = 0.0 to 4.6). No difference in sleepiness and PSQI were noted. Wearing dentures at night resulted in a statistically significantly higher mean score of psychological discomfort when compared to not wearing dentures at night.

Conclusions: The results provide some support to usual practice guidelines to remove dentures at night in edentulous elders suffering from sleep apnea.

Clinical trial registration: NCT01868295.

Keywords: edentulism; nocturnal wear of complete denture; obstructive sleeping apnea; polysomnography; sleep disorders.

© Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.

Figures

Figure 1.
Figure 1.
Trial flowchart.

References

    1. Sanders AE, et al. . Tooth loss and obstructive sleep apnea signs and symptoms in the US population. Sleep Breath. 2016;20(3):1095–1102.
    1. Heidsieck DS, et al. . Management of obstructive sleep apnea in edentulous patients: an overview of the literature. Sleep Breath. 2016;20(1):395–404.
    1. Emami E, et al. . The effect of nocturnal wear of dentures on the sleep quality: a systematic review and meta-analysis. Sleep Breath. 2017;21(1):9–18.
    1. Koshino H, et al. . Tongue motor skills and masticatory performance in adult dentates, elderly dentates, and complete denture wearers. J Prosthet Dent. 1997;77(2):147–152.
    1. Bucca C, et al. . Tooth loss and obstructive sleep apnoea. Respir Res. 2006;7:8.
    1. Ancoli-Israel S, et al. . Prevalent sleep problems in the aged. Biofeedback Self Regul. 1991;16(4):349–359.
    1. Wolkove N, et al. . Sleep and aging: 1. Sleep disorders commonly found in older people. CMAJ. 2007;176(9):1299–1304.
    1. Nguyen AT, et al. . Laryngeal and velopharyngeal sensory impairment in obstructive sleep apnea. Sleep. 2005;28(5):585–593.
    1. Chen Q, et al. . Will wearing dentures affect edentulous patients’ breathing during sleep? Sleep Breath. 2017;21(3):589–594.
    1. Emami E, et al. . Perceived sleep quality among edentulous elders. Gerodontology. 2012;29(2):e128–e134.
    1. Almeida FR, et al. . Complete denture wear during sleep in elderly sleep apnea patients–a preliminary study. Sleep Breath. 2012;16(3):855–863.
    1. Bucca C, et al. . Edentulism and worsening of obstructive sleep apnoea. Lancet. 1999;353(9147):121–122.
    1. Erovigni F, et al. . Cephalometric evaluation of the upper airway in patients with complete dentures. Minerva Stomatol. 2005;54(5):293–301.
    1. Shapira IL. The Nun Study. J Am Dent Assoc. 2008;139(2):130–1; author reply 131.
    1. Emami E, et al. . The relationship of myceliated colonies of Candida albicans with denture stomatitis: an in vivo/in vitro study. Int J Prosthodont. 2007;20(5):514–520.
    1. Cumming CG, et al. . Denture stomatitis in the elderly. Oral Microbiol Immunol. 1990;5(2):82–85.
    1. Felton D, et al. . Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists. J Am Dent Assoc. 2011;142(Suppl 1):1S–20S.
    1. Emami E, et al. . Favoring trauma as an etiological factor in denture stomatitis. J Dent Res. 2008;87(5):440–444.
    1. Iinuma T, et al. . Denture wearing during sleep doubles the risk of pneumonia in the very elderly. J Dent Res. 2015;94(3 Suppl):28S–36S.
    1. Marcus PA, et al. . Complete edentulism and denture use for elders in New England. J Prosthet Dent. 1996;76(3):260–266.
    1. Wilson J. The aetiology, diagnosis and management of denture stomatitis. Br Dent J. 1998;185(8):380–384.
    1. Compagnoni MA, et al. . Relationship between Candida and nocturnal denture wear: quantitative study. J Oral Rehabil. 2007;34(8):600–605.
    1. Sumi Y, et al. . Colonization of dental plaque by respiratory pathogens in dependent elderly. Arch Gerontol Geriatr. 2007;44(2):119–124.
    1. Divaris K, et al. . Loss of natural dentition: multi-level effects among a geriatric population. Gerodontology. 2012;29(2):e192–e199.
    1. Zomorodian K, et al. . Assessment of Candida species colonization and denture-related stomatitis in complete denture wearers. Med Mycol. 2011;49(2):208–211.
    1. Boutron I, et al. ; CONSORT Group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309.
    1. Emami E, et al. . The effect of nocturnal wear of complete dentures on sleep and oral health related quality of life: study protocol for a randomized controlled trial. Trials. 2014;15:358.
    1. Corral-Peñafiel J, et al. . Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome. Eur Respir Rev. 2013;22(129):312–324.
    1. Berry RB, et al. . Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med. 2012;8:597–619.
    1. Tiihonen P, et al. . Evaluation of a novel ambulatory device for screening of sleep apnea. Telemed J E Health. 2009;15(3):283–289.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–545.
    1. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376–381.
    1. Buysse DJ, et al. . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
    1. Slade GD, et al. . Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994;11(1):3–11.
    1. Emami E, et al. . Oral health quality of life and physical health. Int J Health Wellness Soc. 2011;1(1):157–170.
    1. Sumsion T. The Delphi technique: an adaptive research tool. Br J Occup Ther. 1998;61(4):153–156.
    1. American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–689.
    1. Dossing A, et al. . Modified intention-to-treat analysis did not bias trial results. J Clin Epidemiol. 2016;72:66–74.
    1. Edwards BA, et al. . Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2014;190(11):1293–1300.
    1. Pevernagie DA, et al. . On the rise and fall of the apnea-hypopnea index: a historical review and critical appraisal. J Sleep Res. 2020;29(4):e13066.
    1. Dettori JR. Loss to follow-up. Evid Based Spine Care J. 2011;2(1):7–10.

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