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Articles
John C. Chao, D.D.S., F.A.G.D
Anxiety Management,
Behavior Science,
Faculty, USC School of Dentistry
Dentists & Physicians Cooperatively Treat Obstructive Sleep Apnea
Snoring may be a sign of a life-threatening disorder, called obstructive sleep apnea (OSA) and should not be ignored. More and more medical sleep specialists and qualified dentists co-operatively screen and treat OSA.
OSA is characterized by partial or complete closure of the upper airway during sleep resulting in sleep fragmentation (interruption) and oxygen desaturation (lack of oxygen). OSA has been linked to cardiovascular and cerebrovascular disease, leading to adverse events such as heart attacks and strokes. Additionally, OSA is associated with excessive daytime sleepiness and motor vehicle accidents. Published data indicates that individuals with OSA are four to six times more likely to be involved in traffic accidents. It is estimated that each year in the USA, there are 310,000 OSA-related collisions causing 1,400 fatalities and $14.9 billion in collision costs, according to a report published in Sleep, an authoritative journal in sleep medicine. The National Commission on Sleep Disorders Research estimated that drowsiness may be involved in 36% of all fatal accidents and 42-54% of all accidents.
It is estimated that 4% of men and 2% of women in middle age are affected by OSA. This amounts to millions of men and women who suffer from this disorder. Unfortunately only 10% have been diagnosed.
Dentists with special expertise in sleep disorders can help screen for OSA and cooperate with physicians in the treatment of this disease, which is viewed by experts as a significant public health issue.
The risk factors of OSA include male gender, obesity, ethnicity and craniofacial (head-facial) structure. Chronic snoring and daytime tiredness are some of the most common symptoms. Consult with your physician or a qualified dentist if OSA is suspected.
The gold standard for conservative treatment of OSA includes such therapies as weight loss and nasal continuous positive airway pressure (CPAP). Interest in oral devices made by specially trained dentists has been increasing because of the difficulties in patient compliance with the use of CPAP. Essentially an airbag that delivers continuous positive air pressure to the mouth and nose thereby keeping the airway open during sleep. Alternatively, less restrictive oral devices such as a mandibular (lower jaw) advancement splint (MAS) protrude the mandible during sleep to help keep the airway open.
These oral devices are recommended for patients who have been diagnosed with mild or moderate OSA when CPAP is not preferred by the patient. Severe OSA must be treated with CPAP, although mandibular advancement splint may be used to assist in keeping the airway open.
Chronic snoring may be indicative of OSA and should not be ignored. Self-treatment of snoring may merely hide the underlying disease and is deemed not advisable by authorities in sleep medicine. Lack of snoring does not always mean the absence of OSA. An individual may be treated for snoring with a mandibular advancement splint if OSA has been eliminated as a possibility by the physician.
The standard test for sleep apnea, in addition to other ancillary diagnostic procedures, is polysomnography. This test requires the patient to be monitored overnight in a sleep lab. Without this test diagnosis for OSA cannot be definitively established.
The dentist (or physician) may screen for OSA by measuring air flow through the nose by means of a rhinometer and the volume of the upper airway by means of a pharyngometer. In addition, dental offices equipped with CT scan technology may be able to access the upper airway by viewing three-dimensional images of the throat. Furthermore a basic ambulatory (take-home) monitor may used to further screen for signs of OSA. If results indicate OSA, the dentist will refer the patient to a medical sleep specialist for diagnosis and treatment.
Do not ignore chronic, persistent snoring or daytime tiredness. OSA is a life-threatening disorder. If you or your loved one has symptoms of OSA, seek assistance as soon as possible.
