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Theses and Dissertations

Sleep-Disordered Breathing and Mandibular Bone Mass as Assessed Through Panoramic Radiographs Open Access


Other title
Bone Density
Sleep Disordered Breathing
Sleep Apnea
Mandibular Cortical Width
Type of item
Degree grantor
University of Alberta
Author or creator
Eimar, Hazem
Supervisor and department
Flores-Mir, Carlos (University of Alberta- Faculty of Medicine and Dentistry - Division of Orthodontics)
Examining committee member and department
Graf, Daniel (University of Alberta- Faculty of Medicine and Dentistry)
Goal, David (The University of Chicago - Pritzker School of Medicine - Department of Paediatrics)
Plink, Benjamin (The University of British Columbia - Faculty of Dentistry)
Medical Sciences-Orthodontics

Date accepted
Graduation date
2017-11:Fall 2017
Master of Science
Degree level
Sleep-disordered breathing (SDB) and low bone mass (i.e., osteoporosis) are common conditions affecting the adult population with an estimated prevalence of around 15%. Recent studies have assessed a potential association between SDB and reduction in bone mass in adult population. Nevertheless the results of these studies have been inconsistent. Moreover, it is still not known whether this potential association is also manifested in children. This thesis presents a systematic review with meta-analysis to synthesize the existing evidence on the potential association between SDB (including its severe form, i.e., obstructive sleep apnea [OSA]) and low bone mass in adults. In addition, the thesis contains a group of retrospective cross-sectional studies that were conducted in children to test the possible impact of SDB on their bone mass. We first illustrated that the association between SDB (more specifically OSA) and low bone mass in adults is plausible. However, the supporting evidence has potential risk of bias and available data is inconsistent. We next shown, through conducting 2 retrospective cross-sectional studies, that the association between SDB and low bone mass may also exist in children. Indeed, results of the first cross-sectional study illustrated that risk of SDB, as suggested by the Paediatric Sleep Questionnaire (PSQ), may be associated with thinner mandibular cortical thickness (which has been strongly linked to skeletal bone density) in children. This possible association was also supported by the results of the second cross-sectional study, as it was illustrated that in children with a PSG-diagnosed severe form of SDB as induced by OSA was linked to a negative association with mandibular cortical width. We suggested that PSG-diagnosed OSA children had a thinner mandibular cortical width compared to healthy children with no reported sleep-breathing symptoms. Taken together, we believe that the identifying trends support the probable existence of an association between SDB and low bone mass in adults and in children. This should justify the implementation of future studies that rely on large-scale, multi-centers, clinical trials for a better assessment of this possible association for early diagnosis and intervention.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Eimar H, Saltaji H, Ghorashi S, Isfeld D, MacLean JE, Gozal D, Graf D, Flores-Mir C. Association between Sleep Apnea and Low Bone Mass in Adults: A Systematic Review and Meta-Analysis. Osteoporosis International. June 2017, Volume 28, Issue 6, pp 1835–1852. doi: 10.1007/s00198-017-3912-8. Epub 2017 Jan 18.

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