About Dental Sleep Medicine

What happens during incidents of Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a sleep related breathing disorder caused by an obstruction within the airway which causes the sleeping patient to stop breathing. Apnea is defined as “a cessation of airflow for 10 seconds or more”. The tissues in the throat collapse, narrowing the airway, despite one’s efforts to breathe. These episodes can happen few times per hour to many times per hour.

The most common symptom of sleep apnea is that the patient will snore continuously until an apnea episode occurs and they stop breathing. While the person is straining to breathe, there is no snoring sound. These periods of interrupted and restricted breathing are followed by a gasping or choking. In order to breathe, the person with sleep apnea partially awakens. This constant interruption of the person’s sleep, may lead to excessive daytime sleepiness.

The greater concern is that when the airway collapses, oxygen saturation is reduced. At this time, the body is fighting for oxygen, putting immense strain on the heart and increasing blood pressure. Over time, this can damage the heart and lungs, and can lead to heart disease, diabetes, stroke, obesity, and several other co-morbidities.

  Sleep Apnea by the Numbers.

“Obstructive sleep apnea is destroying the health of millions of Americans, and the problem has only gotten worse over the past two decades”, American Academy of Sleep Medicine President Dr. Timothy Morgenthaler.

Current estimates show that as many as 26% of the U.S. population are at high risk for sleep apnea. In a typical dental practice of 1700 patients, 446 of them would be high risk candidates. Here are some other interesting statistics regarding OSA:

  • A person suffering from untreated obstructive sleep apnea is up to 4 times more likely to have a stroke, as well as 3 times more likely to have heart disease.
  • Public health and safety are threatened by the increasing prevalence of obstructive sleep apnea. People suffering from OSA are 6 times more likely to be involved in a car crash than those without sleep disorders.
  • Hypertension, or high blood pressure can be detected in approximately 50% of all patients who have obstructive sleep apnea.
  • Findings from new studies emphasize the negative effects of sleep apnea on the brain and heart health: however, these health risks can be reduced through the effective treatment of sleep apnea. (AASM News Archive)

And, the person at highest risk of sleep apnea is…?

Although there are no definitive characteristics of those persons at high risk for sleep apnea, we do know that age, weight and gender can indicate a higher risk assessment. Here are the characteristics to look for when assessing a patient’s risk of having sleep apnea:

  • Mouth breathers: While it may be hard for you to detect whether a patient is a sleeping mouth breather, you see these people in your chair every day. These are the patients that have trouble breathing when you lean them back. This is usually caused by a nasal obstruction. Excess weight: Fat deposits around the neck and chin may obstruct your breathing. Keep in mind though, not everyone who has sleep apnea is overweight. Thin people suffer from OSA as well.
  • Circumference of the Neck: People with large neck circumferences tend to have narrowed airways as a result. Men with a 17 inch neck size and women with a 16 inch neck size are at higher risk. Another risk factor is excess skin from the chin to the neck, often referred to as a turkey neck.
  • Family History: If the patient has family members who suffer from OSA or snoring, they may be at increased risk. Sleep apnea does have a hereditary link.
  • Alcohol/Other Sedatives: Use of these substances can cause muscles surrounding the airway to relax and cause an obstruction.
  • Smoking: Smoking can cause inflammation and fluid retention in the airway, making smokers 3X’s more likely to have Obstructive Sleep Apnea.
  • Gender: Men are projected to be 2X’s as likely to have sleep apnea. This gap narrows as age increases. The gap narrows as women reach menopause.
  • Age: Adults over the age of 40 are more likely to be candidates for OSA. .
  • Narrow Airway: More common in women than in men, this natural occurrence could be a strong indicator of sleep apnea in women.
  • Enlarged tonsils and/or adenoids: Your tonsils and/or adenoids may become enlarged, which lessens the amount of room for air to pass through your airway. In children, this is the most common cause of sleep apnea, in which removal is the most effective solution.
  • Jaw structure: A lower jaw that is undersized compared to the upper jaw.

The most common symptoms of Sleep Apnea

Usually, the person with sleep apnea does not become aware of their symptoms until the bed partner until the bed partner begins to notice:

  • Loud snoring followed by cessation of breathing
  • Gasping and choking during sleep
  • Excessive daytime sleepiness
  • Morning headaches

Determining if a patient has OSA or just snoring starts with an evaluation of the patient’s health history and physical features. The evaluation will include a screening questionnaire such as the Epworth Sleepiness Scale or STOP BANG. Based on the results of the evaluation, a determination will be made if a sleep study is necessary to determine what type of sleep disorder a person might be suffering from.

The three most common sleep breathing disorders are:

  • Obstructive Sleep Apnea (OSA) means the muscles and tissues in the airway collapse and block off the airway, preventing airflow.
  • Central Sleep Apnea (CSA) is when the brain temporarily stops sending signals to the muscles that control breathing. This sleep breathing disorder commonly affects people with certain neurological medical conditions.
  • Upper Airway Resistance Syndrome (UARS) is usually thought of as severe snoring. UARS is in the middle of snoring and sleep apnea. Normally when snoring gets worse, it becomes UARS, then untreated UARS can turn into OSA. It is thought that UARS is more common in young, thin people, and is most commonly treated with OAT.

What is AHI?

AHI, or the Apnea-Hypopnea Index, is the measurement used to determine the number of apnea events occurred during each hour of sleep. The patient’s AHI can only be determined by an overnight sleep test accomplished in a Sleep Lab or in the patient’s home utilizing a portable sleep device. The overnight sleep test will also measure other characteristics such as oxygen saturation, snoring volume, respiration and others.

The patient’s AHI will determine the severity of their sleep apnea which is indicated in the following manner:

  • AHI 0-5 occurrences = Normal
  • AHI 5-15 occurrences = Mild OSA
  • AHI 15-30 occurrences = Moderate OSA
  • AHI 30+ occurrences = Severe OSA

Treatment options for Obstructive Sleep Apnea

Sleep Apnea can be treated using several methods, including the use of lifestyle changes (to reduce symptoms), oral or dental appliances, surgery, and positive airway pressure (PAP). PAP is the most common and effective treatment for OSA. With PAP, air constantly flows through the nose, moves into the throat and the air pressure keeps the airway open. A PAP system typically has three main parts: a flow generator, which filters room air and produces positive air pressure; a mask or nasal piece which delivers the filtered, pressured air to your airway; and an airflow hose which connects to the other pieces.

Oral Appliance Therapy (OAT) involves the selection, fitting and use of a specially designed removable oral appliance that maintains an open, unobstructed airway in the throat when worn during sleep. Custom-made oral appliances are proven to be more effective than over-the-counter devices. Dentists wanting to provide OAT need to become familiar with the various designs of appliances and which is best suited for the patient’s specific needs. A board-certified sleep medicine physician must first provide adiagnosis and recommend the most effective treatment approach.

What if OSA remains untreated?

Obstructive sleep apnea causes hypertension, diabetes, high blood pressure and if left untreated, could reduce life expectancy by 10 years or more. With 95% of those suffering from obstructive sleep apnea undiagnosed, sleep apnea may be the number one cause of death.

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