Dental Tribune US Edition, Vol. 5, No. 19

1/1 Advert DENTAL TRIBUNE | September 2010 Clinical 9A AD g DT page 10A By Dr. Brock Rondeau, DDS, IBO, DABCP Snoring and sleep apnea It has been estimated that approxi- mately 90 million people in North America suffer from sleep disorders including insomnia, snoring and sleep apnea. Snoring is extremely common in our society, as it has been estimated that 60 percent of men snore and 40 percent of women over age 50 snore. Snoring occurs when there is a partial obstruction of the airway that causes the palatal tissues to vibrate. Snoring is a serious social prob- lem for the bed partner and adverse- ly affects many relationships. I treat many patients where snoring is a sig- nificant negative factor in their lives. Some studies report that the bed partners’ sleep is seriously affected by as much as one hour per night, which can have a negative affect on their health as well due to their lack of adequate sleep (this is similar to the negative health issues associated with second hand smoke). USA Today reported that 27 percent of couples over age 40 sleep in sepa- rate bedrooms. I think there is a direct correlation between this and the inci- dence of snoring. As the incidence of obesity continues to increase in our society, these numbers are going to continue to increase. Sleep apnea is a medical disorder that can only be diagnosed by a sleep specialist in a sleep clinic. The patient must have an overnight sleep study called a polysomnogram that is evalu- ated by the sleep specialist. Many sleep specialists prefer to pre- scribe the CPAP (continuous positive air pressure) device to treat obstruc- tive sleep apnea and do not appreciate the effective role that oral appliances can provide for patients who have mild or moderate OSA (obstructive sleep apnea) or patients who cannot tolerate the CPAP device. A significant breakthrough oc- curred for the dental profession in 2006. In the January issue of the medi- cal journal Sleep, the American Acad- emy of Sleep Medicine (medical sleep specialists) issued guidelines stating that for patients with mild to moderate obstructive sleep apnea, the oral appli- ance was the No. 1 treatment option. The guidelines also stated that oral appliances were a viable option for treatment for patients who do not respond to weight loss or have tried the CPAP device and were unable to tolerate it. The diagnosis for OSA is made using an apnea-hypopnea index (AHI). The diagnosis is made during an overnight sleep study in a hospital or private sleep clinic. This sleep study is known as a PSG (polysomnogram). The number of apneic and hypopnic events are recorded as follows: Sleep apnea: tongue completely blocks airway • apnea: a cessation of breath for 10 seconds or more • hypopnea: the blood oxygen level decreases 4 percent or more ces- sation of breath for less than 10 seconds • mild sleep apnea (osa): 5–15 events per hour • moderate sleep apnea (osa): 16–30 events per hour • severe sleep apnea (osa): more than 30 events per hour There are three treatment options for obstructive sleep apnea: • oral appliances • CPAP device (continuous positive air pressure) • surgical removal of structures causing the obstruction The diagnosis of obstructive sleep apnea can only be made by a medical professional, and it is usually a sleep specialist. Therefore, dentists must send their patients to a hospital or pri- vate sleep clinic for a polysomnogram (16-channel overnight sleep study). Only when the written report is received from the sleep center can the dentist proceed with the fabrication of oral appliances. The dentist should review the sleep study with the patient once the AHI How they can adversely affect relationships and health