Obstructive Sleep Apnea, a summary
Hey there Dr. Matt here, here is an update on Obstructive Sleep Apnea. First off Dentists cannot diagnose OSA but Physicians can. Second Physicians cannot make mouth appliances to treat OSA. Having said that, here is a current summary.
OSA affects approximately 20% of the US adults. 90% of whom are undiagnosed. There is a well-known link between obesity rates and sleep apnea. A quick guide is the Mayo Clinic BMI (body mass index)
There exists a vicious cycle: sleep deprivation from OSA causes people to eat more and feel too tired to exercise, which leads to weight gain, which can exacerbate existing OSA or bring on new occurrences.
In people with OSA breathing stops repeatedly for 10 seconds or more during “sleep”. It occurs because the muscles in the back of the throat collapse, and cause the airway to narrow and close. Your bed partner will know because of choking or gasping sounds when this occurs, not just snoring.
Medical histories often indicate chronic snoring, excessive fatigue, difficulty concentrating, depression, irritiability, headaches, learning difficulties, and memory loss problems. Risk factors include being overweight/obese as mentioned above, smoking, drinking alcohol, being 40 or older, having a large neck, and having a small airway to begin with.
Take the “STOP-BANG” questionnaire and see for yourself.
If you score poorly then there are other questionnaires your Dentist will use to refer you to a sleep center Doctor who can diagnose you. The Doctor will order a Sleep Study with a Polysomnogram. A Polysomnogram measures physiological changes during sleep, such as rapid eye movements (REM sleep), electrical activity in the brain (what levels of sleep you reach), muscle activity, heart rhythms, blood oxygen levels, and air flow in and out of the lungs. The results are reviewed and a diagnosis of mild, moderate or severe OSA is made.
Often mild OSA can be managed with weight loss, non smoking, no alcohol, sleeping on the side, using nasal sprays or allergy medications, anything to open up the airway.
Moderate to Severe OSA discussions center around Apnea-Hypopnea Index (AHI mild 5-15, moderate 15-30, over 30 severe) and the blood oxygen saturation levels (96% normal, below 80% horrible, and inbetween). Simply number of sleep interruptions and how oxygenated you are.
The gold standard of treatment for OSA is CPAP (continuous positive airway pressure). Less than 50% of patients continue to use CPAP therapy even though it is potentially lifesaving. For those that cannot tolerate a CPAP a Mouthpiece (MAD: madibular advancement device) can be made by a Dentist).
A second sleep study can be made with the use of CPAP and/or MAD (mouthpiece in place). This is useful since it tells all the true quality of the treatment intervention.
I hope that this was helpful and you will let us know at your next appointment if you need help.
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