Effect of Sleep Apnea on Pain After Dental Treatment

Study Design and Power Analysis This observational study was designed to evaluate the interaction between Obstructive Sleep Apnea (OSA) and systemic diseases on postoperative pain following endodontic treatment. A power analysis was performed using G*Power 3.1 software with parameters f=0.40, α=0.05, and 80% power. While the analysis indicated a minimum of 66 participants, a total of 75 participants were targeted to account for a potential 15% dropout rate. The study was completed with 78 participants, maintaining and enhancing the required statistical power.

Participant Selection and Grouping

Patients aged 28 to 63 were enrolled based on their clinical status and divided into three groups:

Group 1 (n=24): Patients diagnosed with moderate (AHI 15-30) or severe (AHI >30) OSA via polysomnography (PSG) in an accredited sleep laboratory, who also presented with systemic diseases (Diabetes Mellitus and/or Hypertension).

Group 2 (n=24): Patients with diagnosed systemic diseases (Diabetes Mellitus and/or Hypertension) but without OSA.

Group 3 (n=30): Systemically healthy individuals without OSA (Control Group).

Exclusion criteria

included the presence of periapical lesions on preoperative radiographs, chronic analgesic use, pregnancy, and failure to complete the study protocol. To minimize bias, the research team was blinded to the OSA classification process, and the data analyst was blinded during the statistical evaluation.

Standardized Endodontic Protocol To eliminate operator variability, all treatments were performed by a single experienced endodontist in a single session. Procedures were conducted under local anesthesia (2% lidocaine with 1:80,000 epinephrine) and rubber dam isolation. Root canal preparation was standardized using the VDW.ROTATE™ system up to a size 25.06 taper. The irrigation protocol included 5.25% NaOCl, 17% EDTA, and a final rinse with distilled water. Canals were obturated using the single-cone gutta-percha technique with AH Plus sealer.

Evaluation and Statistical Analysis Preoperative pain levels and postoperative pain at the 6th hour, 24th hour, and 7th day were recorded using a 10-point Visual Analog Scale (VAS) (0: no pain, 10: severe pain). The primary outcome was the difference in postoperative VAS scores between groups, while the secondary outcome was the duration of pain. Statistical analysis was performed using SPSS version 25. Due to non-normal distribution (confirmed via Kolmogorov-Smirnov test), the Kruskal-Wallis test with Bonferroni correction and the Mann-Whitney U test were utilized. The significance level was set at p < 0.05.

Inclusion criteria

• Patients aged between 18 and 65 years.
• Clinical requirement for endodontic (root canal) treatment.
• Presence of a restorable tooth structure.
• Diagnosis of moderate (AHI 15-30) or severe (AHI > 30) obstructive sleep apnea (OSA) confirmed by polysomnography, for relevant groups.
• Patients with diagnosed systemic diseases (Diabetes Mellitus and/or Hypertension) or systemically healthy controls according to group allocation.

Exclusion criteria

• Presence of periapical lesions identified during preoperative radiographic evaluation.
• Chronic use of analgesics or long-term pain-management medications.
• Pregnancy.
• Failure to complete the established study protocol.