SLEEP APNOEA AND DENTAL SLEEP MEDICINE

Not everyone snores has sleep apnoea and not all sleep apnoea sufferers snore.

 

What is sleep apnoea? What are different types of sleep apnoea?

There are 3 types.

1. Central Sleep Apnea (CSA)

CSA occurs when there is a communication problem between the brain and the breathing muscles and there is no muscular effort to take a breath.   CSA may occur in premature or full-term infants. It is defined as apneas that last 20 seconds or longer and often accompanied by a change in heart rate, a reduction in blood oxygen and a general relaxation of the body’s muscles (hypotonia).   In infants, the CSA is treated with an apnea alarm.   In adults, the CSA often associated with other medical problems and hence treatment involves treating the underlying causes.

2. Obstructive Sleep Apnoea (OSA)

OSA occurs when there is a signal from the brain to the breathing muscles. The muscles make an effort for a breath but it is unsuccessful due the obstruction of the airway. An adequate flow of air is impossible. More information on OSA will be seen later on this topic

3. Mixed Sleep Apnoea

Both CSA and OSA present.

Due to its relevance of Obstructive Sleep Apnea and dentistry, this page mainly discusses OSA.

OBSTRUCTIVE SLEEP APNOEA IS A FORM OF SLEEP DISORDER BREATHING

Prevalence of Sleep Apnea

  • At least 5% of the Australia population has a degree of sleep apnea syndrome with only 1-20% diagnosed and treated
  • As the Australian population getting more obese, the prevalence will rise if BMI >30 (body mass index), the risk of sleep apnea increases from 3-5% to 20-40%
  • Cost to the community estimated at $3-7 billion per annum

(Proposal for a National Sleep Health Agenda, The Boston Consulting Group. 2003)

Sleep Disorder Breathing and other Related Health Problems

  • Drug-Resistant Hypertension
  • Obesity
  • Congestive Heart Failure
  • Pacemakers
  • Atrial Fibrillation
  • Impaired glucose tolerance and Diabetes
  • All hypertension in males
  • Coronary Artery Disease in males
  • Sudden Cardiac Death
  • Systemic Inflammatory State
  • Difficulty with anaesthesia, waking post-anaesthetics and airway maintenance
  • Affecting the neuro-cognition: increased motor vehicle accidents (MVA), occupational accidents, difficulty in concentrating and performing new tasks, decrease quality of life. In Australia, MVA related directly to fatique, 33% of crashes are attributed to sleepiness. 20-30% of accidents caused by commercial drivers are sleep related and a large proportion of that related to Sleep Disorder Breathing. (Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd Monash University accident Research Centre, Nov 2010)
  • Depression
  • Increase Cancer Risk
  • Deep Vein Thrombosis

Sleep disorders underlie

  • 1% of work related injuries
  • 3% of depression
  • 6% of non-related motor vehicle accidents
  • 9% of diabetes 0.6% of cardiovascular disease

( Hillman, DR Murphy, AS Antic, R Pezullo, L 2006. The economic cost of sleep disorders. Sleep 2006)

Why is it so important to discuss your sleep problems, obstructive sleep apnea with your dentist and cooperate in the investigations and treatment?

A lot of signs and symptoms of obstructive airways, obstructive sleep apnea present in your head and neck. There are no other general health care providers who are better educated in the field of head and neck more than dentists.

Dentists such as Dr Linhlan Nguyen and her colleagues at Kaleen Dental Care and Facial Aesthetics ® are probably trained for Dental Sleep Medicine using the physiologic approach to ensure you get the result quicker and the treatment such as the titratable Mandibular Advancement Splint more comfortable.

Symptoms of sleep disorders and Sleep Disorder Breathing

  • Loud repetitive snoring
  • Witnessed apneas
  • Choking or gasping during sleep, dry cough through the night
  • Recurrent awakening overnight
  • Nocturia
  • Restless sleep/ insomnia
  • Waking with headache
  • Unrefreshing sleep
  • Impaired concentration
  • Impotence
  • Reduced motivation
  • Breathlessness
  • Excessive daytime sleepiness/ fatigue
  • Irritabilities/personality changes
  • Alteration in vigilance, alertness, memory
  • Disturbance in general intellectual function
  • Reduced exercise tolerance
  • In children, symptoms can also be seen as: loud breathing, snore, constant changing sleep position, dark venous pulling under eyes, cranky waking up in the morning, difficulty concentrating at school, easily tired in physical activity, hyper-active, under-active, failure to thrive
  • Teeth grinding, painful TMJ
  • Frequent teeth and restoration fractures
  • Enamel erosion
  • Acid reflux
  • Severe bone loss in non-gum disease dentition, can be localized or generalised

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