The association between sleep disturbances and tooth loss among post-stroke patients

ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

摘要
研究背景：牙齿缺失与神经系统疾病及睡眠障碍密切相关，其被认为是脑卒中的预测因子，可引发气道通畅性改变，增加阻塞性睡眠呼吸暂停（obstructive sleep apnea）的发病倾向。
研究目的：本研究旨在调查圣保罗联邦大学神经血管门诊就诊的伴牙齿缺失的脑卒中后患者的睡眠质量、阻塞性睡眠呼吸暂停发病风险及日间过度嗜睡情况。
研究方法：本研究纳入130名存在不同程度牙齿缺失的脑卒中患者，评估其不同类型脑卒中的患病率，同时调查睡眠障碍、阻塞性睡眠呼吸暂停发病风险及日间过度嗜睡的发生情况。
研究结果：本研究中缺血性脑卒中（ischemic stroke）患病率为94.6%，患者多无明显残疾或仅存在轻度残疾。研究对象普遍存在睡眠质量不佳及较高的阻塞性睡眠呼吸暂停发病风险，但未出现日间过度嗜睡情况。有一半的研究对象缺失9~31颗牙齿，超过25%的研究对象为无牙症（edentulism）。多数患者使用全口可摘义齿，且其中超过半数的人群睡眠时未摘下义齿。
研究结论：本研究发现，伴牙齿缺失的脑卒中后患者普遍存在睡眠质量不佳及较高的阻塞性睡眠呼吸暂停发病风险，提示需针对伴牙齿缺失的脑卒中患者开展睡眠障碍治疗与预防相关的进一步研究。