Periodontal disease and obstructive sleep apnea: an umbrella review

Aim To synthesize and critically appraise the existing evidence on the association between periodontal disease (PD) and obstructive sleep apnea (OSA) through an umbrella review. Material and methods A comprehensive search was conducted across databases including PubMed, Cochrane Library, Scopus, Web of Science, Embase, SciELO, Google Scholar, ProQuest Dissertations and Theses, and OpenAIRE, covering literature up to December 2025. Systematic reviews, with or without meta-analysis, that assessed the association between PD and OSA were included. Narrative reviews, rapid reviews, clinical trials, observational or experimental studies, case reports, editorials, letters, protocols, and posters were excluded. The methodological quality of the reviews was evaluated using the AMSTAR-2 tool, and the risk of bias was assessed using the ROBIS tool. Results From an initial retrieval of 217 records, 11 systematic reviews met the inclusion criteria. The included reviews consistently reported a positive association between PD and OSA, although variability in diagnostic criteria and study design was observed. Conclusion Based on systematic reviews with low risk of bias and high overall confidence, the available evidence indicates a consistent association between PD and OSA. However, due to the predominantly observational nature of the primary studies, causality cannot be inferred, and further longitudinal and interventional research is warranted. Systematic Review Registration Open Science Framework (OSF), DOI: 10.17605/OSF.IO/RMQWC , URL: https://osf.io/udyjq/ .