Breathing difficulties occuring at night are called sleep disordered breathing, and the most severe is obstructive sleep apnea (OSA), which affects more than 10% of the adult population. Dentists may identify patients at risk for the disorder and refer them for accurate diagnosis. OSA has links to coronary artery disease, hypertension, heart failure, obesity, stroke, and many other syndromes spanning all age groups. Identification and referral of patients at risk and oral appliance therapy can help 43% to 56% of these patients regain normal breathing patterns at night. Sleep apnea occurs when the upper airway is partially or completely obstructed during sleep, regardless of the intake of air. Airway obstruction causes loss of oxygen circulating in the bloodstream, carbon dioxide buildup, and forced “waking,” which interferes with normal sleep patterns. The upper airway can collapse at any point along its length, and a CT scan is necessary to locate the obstruction. Obstructions can occur when patients sleep on their back and the tongue and soft palate are forced backward by gravity. Collapse can also be caused by lack of sleep, alcohol consumption, and nasal congestion. Sleep apnea can occur in as many as 20% of those over age 60, but it can also occur in newborns, children, teens, and adults. Populations that appear to be at high risk of OSA include 50% of Down syndrome patients, 50% of patients with pacemakers, 66% of women with polycystic ovary disease, 50% of children needing rapid palatal expansion for posterior crossbites, and patients with repaired cleft palates. Many patients with OSA tend to exhibit sleepiness during the day, impacting work and relationships. Accurate diagnosis of OSA is made by means of nocturnal polysomnography in a sleep lab. Data is gathered on breathing, EEG patterns, muscle activity, airflow, arterial oxygen saturation, body position, snoring, bruxism, and clenching. These data indicate the severity of the disease and determine treatment methodology. Continuous positive airway pressure and oral appliance therapy are 2 common forms of treatment. Oral appliance therapy is used with mild to moderate OSA, but is not as effective as continuous positive airway pressure, according to the American Academy of Sleep Medicine. By partnering with physicians, dentists can have a positive impact on the health and quality of life of these patients.
(Source: Journal of the Massachusetts Dental Society, Spring 2008, Volume 57, Number 1)
