General Information – Sleep Apnea
Obstructive sleep apnea is a sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort and is characterized by recurrent episodes of upper airway collapse that occurs many times nightly. The sufferer is unable to sleep thoroughly, as they are frequently aroused by their own physiological need for air. An apnea is defined as the cessation of airflow for at least 10 seconds; of course these can last for over half a minute or more and as frequently as 1-2 a minute (every minute, every hour of sleep). OSA is associated with a number of diseases, including; high blood pressure, stroke, heart failure, heart attack, pulmonary hypertension, type II diabetes, erectile dysfunction, depression, memory loss and numerous other health problems. Past research has shown that patients suffering from untreated OSA are two to three times more likely to be involved in traffic accidents than the general population and are at high risk for injury in the workplace. In children and teens OSA is linked to lower academic grades and problematic behavior, as it is associated with inattention, fatigue and possibly poor study skills.
OSA is enormously under-diagnosed and under-treated condition, frequently missed and misdiagnosed by well-meaning physicians. Dentists are perfectly suited to be first in line to screen patients for OSA, as many of the signs and symptoms frequently involve the structure and development of the face and oral cavity. OSA is associated with soft tissue collapse in the pharynx, however, many sufferers also have long narrow faces, small lower jaws and/or chins, small and narrow dental arches, large overbites, crooked teeth, large tongues, flat facial features, high and narrow palate and large noses. The soft tissue collapse is often due to mid-facial deficiency, where bony structure is inadequately spaced to provide ample room for the soft tissue laxity that occurs in sleep.
Treatment options include continuous positive airway pressure (CPAP) (considered the gold standard), dental devices that push the lower jaw down and forward MAS (mandibular advancement splint), dental appliance that captures the tongue TRD (tongue retraining device), surgery that reduces the amount of soft tissue, surgery that advances the jaws forward and appliances that gradually change the morphology of the face and oral cavity.