Uyku–Periodontitis İlişkisi: Biyolojik Mekanizmalar, Epidemiyolojik Kanıtlar ve Klinik Yansımalar
Özet
Uyku, immün yanıtın düzenlenmesi, nöroendokrin dengenin korunması ve metabolik homeostazın sürdürülmesinde merkezi rol oynayan temel bir fizyolojik süreçtir. Uyku süresindeki kısalma ya da uzama, uyku kalitesindeki bozulmalar ve farklı uyku bozuklukları; sistemik inflamasyon, oksidatif stres, hormonal düzensizlikler, davranışsal değişiklikler ve eşlik eden sistemik hastalıklar aracılığıyla periodontal dokuların sağlığını etkileyebilmektedir. Bu bölümde, uyku ile periodontitis arasındaki ilişkiyi inceleyen güncel epidemiyolojik, klinik ve biyolojik kanıtlar kapsamlı biçimde değerlendirilmiştir. Toplum temelli çalışmalar, uyku süresi ile periodontitis arasında anlamlı ilişkiler bulunduğunu ve bu ilişkinin bazı popülasyonlarda U-şekilli bir dağılım gösterebildiğini ortaya koymaktadır. Bunun yanında, düşük uyku kalitesi, yetersiz dinlendirici uyku ve bazı uyku bozukluklarının periodontal hastalıkların görülme sıklığı ve şiddeti ile ilişkili olabileceği bildirilmektedir. Stres, diyabet, hipertansiyon, obezite, sigara kullanımı ve sosyoekonomik değişkenler gibi çok sayıda faktörün bu ilişkiyi etkileyebileceği anlaşılmaktadır. Bununla birlikte, mevcut literatürün önemli bir kısmının kesitsel çalışmalara dayanması, nedensellik ilişkilerinin net olarak ortaya konulmasını sınırlamaktadır. Sonuç olarak, uyku ile ilişkili değişkenler periodontal hastalıkların etiyopatogenezinde ve risk değerlendirmesinde dikkate alınması gereken çok boyutlu bir bileşen olarak ele alınmalıdır.
Sleep is a fundamental physiological process that plays a central role in regulating immune response, maintaining neuroendocrine balance, and preserving metabolic homeostasis. Shortened or prolonged sleep duration, impaired sleep quality, and various sleep disorders may adversely affect periodontal tissue health through systemic inflammation, oxidative stress, hormonal dysregulation, behavioral changes, and accompanying systemic conditions. In this chapter, current epidemiological, clinical, and biological evidence examining the relationship between sleep and periodontitis is comprehensively evaluated. Population-based studies have demonstrated significant associations between sleep duration and periodontitis, with some findings suggesting a U-shaped pattern in certain populations. In addition, poor sleep quality, insufficient restorative sleep, and certain sleep disorders have been reported to be associated with the prevalence and severity of periodontal diseases. Multiple factors, including stress, diabetes, hypertension, obesity, smoking, and socioeconomic variables, may further influence this relationship. Nevertheless, the predominance of cross-sectional studies in the existing literature limits the ability to establish clear causal inferences. Overall, sleep-related variables should be considered a multidimensional component in the etiopathogenesis and risk assessment of periodontal diseases.
Referanslar
Muniz FWMG, Pola NM, Silva CF, et al. Are periodontal diseases associated with sleep duration or sleep quality? A systematic review. Archives of Oral Biology. 2021;129:105184. doi:10.1016/j.archoralbio.2021.105184.
Ivanov I, Maynalovska H. Inflammatory components in sleep disorders and plaque-associated periodontal diseases and their possible interrelation. Problems of Dental Medicine. 2025;51:1-7. doi:10.3897/pdm.51.e170939.
Liu M, Wu Y, Song J, et al. Association of Sleep Duration with Tooth Loss and Periodontitis: Insights from the National Health and Nutrition Examination Surveys (2005-2020). Sleep and Breathing. 2024;28:1019-1033. doi:10.1007/s11325-023-02966-2.
Romandini M, Gioco G, Perfetti G, et al. The association between periodontitis and sleep duration. Journal of Clinical Periodontology. 2017;44:490-501. doi:10.1111/jcpe.12713.
Schmidlin PR, Khademi A, Fakheran O. Association between periodontal disease and non-apnea sleep disorder: a systematic review. Clinical Oral Investigations. 2020;24:3335-3345. doi:10.1007/s00784-020-03475-2.
Islam MM, Ekuni D, Toyama N, et al. Association between Sleep Quality and Duration and Periodontal Disease among University Students: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2020;17:3034. doi:10.3390/ijerph17093034.
Kamalian Mehrizi F, Hosseini Yekani A, Rashidi Maybodi F. Association between Sleep Quality and Periodontal Status: A Case-Control Study. Journal of Dentistry (Shiraz University of Medical Sciences). 2025;26(1):69-75. doi:10.30476/dentjods.2024.101184.2278.
Al-Jewair T, Al-Jasser R, Almas K. Periodontitis and obstructive sleep apnea's bidirectional relationship: a systematic review and meta-analysis. Sleep and Breathing. 2015;19:1111-1120. doi:10.1007/s11325-015-1160-8.
Han K, Park Y-M, Park J-B. Evaluation of an association between long sleep duration and periodontal disease among men and women using nationally representative data. Gaceta Sanitaria. 2018;32(2):143-150. doi:10.1016/j.gaceta.2017.01.013.
Alqaderi H, Goodson JM, Agaku I. Association between sleep and severe periodontitis in a nationally representative adult US population. Journal of Periodontology. 2020;91:767-774. doi:10.1002/JPER.19-0105.
Han DH, Kim MS, Kim S, et al. Sleep time and duration are associated with periodontitis in a representative sample of Koreans. Journal of Periodontology. 2022;93:210-219. doi:10.1002/JPER.20-0252.
Jerard E, et al. Evaluation of relationship between sleep and periodontal health: cross sectional study. Journal of the Society of Periodontists and Implantologists of Kerala. 2018;10(3).
Lee S-H. Relationship of Sleep Duration to Periodontal disease in Youth. Journal of Digital Convergence. 2017;15(9):311-319. doi:10.14400/JDC.2017.15.9.311.
Do KY, Lee ES. Relationship between subjective sleep quality and periodontal disease-related symptom in the Korean adolescent population. Journal of Korean Society of Dental Hygiene. 2021;21(5):575-583. doi:10.13065/jksdh.20210055.
Marruganti C, Gaeta C, Romandini M, et al. Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study. Journal of Periodontology. 2024;95:125-134. doi:10.1002/JPER.23-0209.
Carra MC, Schmitt A, Thomas F, et al. Sleep disorders and oral health: a cross-sectional study. Clinical Oral Investigations. 2017;21:975-983. doi:10.1007/s00784-016-1851-y.
Movahed E, Moradi S, Mortezagholi B, et al. Investigating oral health among US adults with sleep disorder: a cross-sectional study. BMC Oral Health. 2023;23(1):996. doi:10.1186/s12903-023-03686-5.
Kong J, Wang H. The Association Between Sleep Status And Periodontitis: A Preliminary Study. International Dental Journal. 2025;75(Suppl 1):104119. doi:10.1016/j.identj.2025.104119.
Referanslar
Muniz FWMG, Pola NM, Silva CF, et al. Are periodontal diseases associated with sleep duration or sleep quality? A systematic review. Archives of Oral Biology. 2021;129:105184. doi:10.1016/j.archoralbio.2021.105184.
Ivanov I, Maynalovska H. Inflammatory components in sleep disorders and plaque-associated periodontal diseases and their possible interrelation. Problems of Dental Medicine. 2025;51:1-7. doi:10.3897/pdm.51.e170939.
Liu M, Wu Y, Song J, et al. Association of Sleep Duration with Tooth Loss and Periodontitis: Insights from the National Health and Nutrition Examination Surveys (2005-2020). Sleep and Breathing. 2024;28:1019-1033. doi:10.1007/s11325-023-02966-2.
Romandini M, Gioco G, Perfetti G, et al. The association between periodontitis and sleep duration. Journal of Clinical Periodontology. 2017;44:490-501. doi:10.1111/jcpe.12713.
Schmidlin PR, Khademi A, Fakheran O. Association between periodontal disease and non-apnea sleep disorder: a systematic review. Clinical Oral Investigations. 2020;24:3335-3345. doi:10.1007/s00784-020-03475-2.
Islam MM, Ekuni D, Toyama N, et al. Association between Sleep Quality and Duration and Periodontal Disease among University Students: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2020;17:3034. doi:10.3390/ijerph17093034.
Kamalian Mehrizi F, Hosseini Yekani A, Rashidi Maybodi F. Association between Sleep Quality and Periodontal Status: A Case-Control Study. Journal of Dentistry (Shiraz University of Medical Sciences). 2025;26(1):69-75. doi:10.30476/dentjods.2024.101184.2278.
Al-Jewair T, Al-Jasser R, Almas K. Periodontitis and obstructive sleep apnea's bidirectional relationship: a systematic review and meta-analysis. Sleep and Breathing. 2015;19:1111-1120. doi:10.1007/s11325-015-1160-8.
Han K, Park Y-M, Park J-B. Evaluation of an association between long sleep duration and periodontal disease among men and women using nationally representative data. Gaceta Sanitaria. 2018;32(2):143-150. doi:10.1016/j.gaceta.2017.01.013.
Alqaderi H, Goodson JM, Agaku I. Association between sleep and severe periodontitis in a nationally representative adult US population. Journal of Periodontology. 2020;91:767-774. doi:10.1002/JPER.19-0105.
Han DH, Kim MS, Kim S, et al. Sleep time and duration are associated with periodontitis in a representative sample of Koreans. Journal of Periodontology. 2022;93:210-219. doi:10.1002/JPER.20-0252.
Jerard E, et al. Evaluation of relationship between sleep and periodontal health: cross sectional study. Journal of the Society of Periodontists and Implantologists of Kerala. 2018;10(3).
Lee S-H. Relationship of Sleep Duration to Periodontal disease in Youth. Journal of Digital Convergence. 2017;15(9):311-319. doi:10.14400/JDC.2017.15.9.311.
Do KY, Lee ES. Relationship between subjective sleep quality and periodontal disease-related symptom in the Korean adolescent population. Journal of Korean Society of Dental Hygiene. 2021;21(5):575-583. doi:10.13065/jksdh.20210055.
Marruganti C, Gaeta C, Romandini M, et al. Multiplicative effect of stress and poor sleep quality on periodontitis: A university-based cross-sectional study. Journal of Periodontology. 2024;95:125-134. doi:10.1002/JPER.23-0209.
Carra MC, Schmitt A, Thomas F, et al. Sleep disorders and oral health: a cross-sectional study. Clinical Oral Investigations. 2017;21:975-983. doi:10.1007/s00784-016-1851-y.
Movahed E, Moradi S, Mortezagholi B, et al. Investigating oral health among US adults with sleep disorder: a cross-sectional study. BMC Oral Health. 2023;23(1):996. doi:10.1186/s12903-023-03686-5.
Kong J, Wang H. The Association Between Sleep Status And Periodontitis: A Preliminary Study. International Dental Journal. 2025;75(Suppl 1):104119. doi:10.1016/j.identj.2025.104119.
