What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a life-threatening condition that affects over 18 million Americans. This commonly undiagnosed syndrome involves the cessation of breathing during sleep. While sleeping, the upper airway muscles enter relaxation and may vibrate against each other (this vibration is what causes snoring). As sleep deepens, muscle relaxation increases and can occlude the airway. This severely decreases the amount of oxygen flowing to the lungs. The body responds to this lack of oxygen by sending a signal to your brain that you are suffocating. The brain compensates by lightening the phase of sleep in order to increase control and contraction of upper airway muscles, ultimately increasing oxygen flow to the lungs. This constant exchange between suffocation and arousal can occur several times throughout the night and many do not recall it happening upon fully awakening the next morning.
Is Treating OSA Important?
While studies estimate 1 in 4 Americans over the age of 18 (31% of men and 21% of women) are considered “high risk” for sleep apnea, 90% of those with sleep apnea have gone undiagnosed.1 If left untreated, sleep apnea can increase the risk of health issues, including cardiovascular disease (stroke, high blood pressure, and atrial fibrillation), diabetes, impotence, memory loss, and GERD. Excessive fatigue caused by OSA can affect your safety by increasing your risk of motor vehicle accidents and work-related accidents. Untreated severe OSA also increases your risk of death.
Figure 1: According to Dental Sleep Solutions, fewer than 10% of those suffering with OSA have been accurately diagnosed and only 25% of those diagnosed have been successfully treated. This chart indicates the large percentage of Americans who have gone undiagnosed with this condition.1
Symptoms of Sleep Apnea
During your appointments, your dentist and dental hygienist are examining much more than your teeth. During your head and neck exam and oral cancer screening, we are also analyzing your anatomy to determine your risk of OSA. These anatomical features include swollen tonsils, an enlarged tongue, inflamed sinus membranes, an anatomically small airway, malocclusion, and obesity (excess fatty deposits on the neck and chest).
Figure 2: Health professionals use the Mallampati Classification system (above) to determine your risk of OSA.
Patients with Class I and Class II Mallampati scores have lower risks of OSA since their airways are mostly patent (open). Patients who are in the Class III and IV range are at a much higher risk of OSA due to the obstruction of their soft palate.
There are also many symptoms of OSA that you may notice about you or your partner between dental appointments:
- Waking up due to gasping or choking
- Excessive day time fatigue
- Waking up feeling unrefreshed/Restless sleep
- Waking up with xerostomia (dry mouth)
- Morning headaches/migraines
If you notice any of these symptoms for yourself or your loved ones, you should report them to your doctor or hygienist as soon as possible.
I May Have Sleep Apnea – What Should I Do?
If you notice any of the common sleep apnea signs with you or your loved ones, contact your dentist right away! At our office, we have ways to screen you for sleep apnea at home and can work with your doctor to find the best treatment option for you. There are several routes of treatment depending on the severity of your OSA.
One of the first steps in diagnosing OSA is performing a sleep study. This can be done with the help of your physician and a sleep lab or it can be completed out of the comfort of your own home. At our office, we use a DDME Nox Airway Monitoring System to monitor your oxygen intake and pulse rate while you sleep at home. Once your results are recorded, a board certified sleep physician will analyze them and send your dentist a summarized report. Next, your dentist will discuss treatment options with you. The three common treatment options for OSA include a continuous positive airway pressure (CPAP), oral appliance therapy (OAT), and surgery.
- CPAP Therapy is the most common treatment method for OSA. It involves wearing a face mask that connects to a machine via plastic tubing. The machine forces oxygen through the mask at a continuous rate, predetermined by your doctor, throughout the night. This was the gold standard for treatment of OSA until recently as it is highly effective in maintaining oxygen intake during sleep. However, its efficacy is often diminished by the lack of patient compliance. Patients often find that it is not comfortable and only wear it for an average of three hours per night.
- Advantages: considered most effective treatment of all severities of OSA
- Disadvantages: mask discomfort, not easy to travel with, nose/throat dryness
- Oral Appliance Therapy has recently risen in popularity as a comfortable alternative to CPAP. It utilizes a custom device that fits similarly to a sports mouth guard or an orthodontic retainer and maintains an open airway by repositioning your lower jaw and tongue slightly forward. Studies have found that OAT and CPAP are both effective OSA treatments. The Journal of Clinical Sleep Medicine reported that patients prefer OAT over CPAP because it is quiet, portable, and comfortable.2
- Advantages: least invasive, comfortable, quiet, portable, does not require electricity to work, easy and inexpensive to clean
- Disadvantages: may not be as effective with severe cases of OSA
- Surgical Options often involve soft tissue and/or jaw surgery to increase airway opening. While these surgeries have varying degrees of success, nonsurgical options are typically recommended prior to proceeding with this route.
- Advantages: most surgeries are effective in long-term improvement of airway
- Disadvantages: most invasive, requires post-operative recovery
- OSA is a life-threatening condition that is grossly undiagnosed in the United States.
- Treatment options for OSA include: CPAP, OAT, and surgery.
- While CPAP has been deemed the “gold standard” for OSA treatment, its effectiveness is compromised by patient intolerance and unwillingness to wear it. Patients who have tried CPAP and (1) did not have good results or (2) were not able to tolerate it should consider trying OAT.
- If you or someone you know may have OSA, contact your dental office today!
Thank you for visiting our blog! As always, feel free to contact our Ellicott City, MD office to learn more!
1Dental Sleep Solutions. “What is OSA Syndrome?” 2014. Web. 21 Feb. 2017.
2Ramar, K. "Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015." AASM. American Academy of Sleep Medicine, 2015. Web. 21 Feb. 2017.