Obstructive sleep apnea: What we know and how to treat it


Obstructive sleep apnea (OSA) has a global prevalence of 9-38%, with instances in the US estimated at round 54 million. Surprisingly, about 80% of OSA instances stay undiagnosed. OSA is taken into account a sleep-related respiration dysfunction that accounts for obstruction of the higher airway, inflicting apneas. As well as, the obstruction attributable to OSA results in intermediate results corresponding to sleep fragmentation, coronary heart charge fluctuations, hypoxia, amongst others.

The prevalence of OSA is greater amongst African Individuals, Native Individuals and Hispanics. Literature demonstrates racial disparities in presentation, prevalence, analysis, threat components and OSA remedy. Usually, reasonable to extreme OSA instances happen in one-fifth of middle-aged males and one-tenth of middle-aged ladies. Nonetheless, in response to the Hispanic Neighborhood Well being Examine/Examine of Latinos (HCHS/SOL), Puerto Rican ladies have the best sleep apnea prevalence. In distinction, Puerto Rican males have the bottom.

Comorbidities related to OSA embody substance abuse, alcohol use, tobacco, decreased productiveness, stress and accidents. These resulted in prices averaging $150 billion to the US in 2015. Psychological well being, cardiovascular issues, metabolic illnesses, diabetes, renal illnesses and most cancers are all related to OSA. The manifestations of OSA embody mattress companion disturbance, temper issues, daytime sleepiness, fatigue, insomnia and hypersomnolence, with signs starting from loud night breathing or apnea episodes to cardiovascular penalties. Moreover, tongue dimension and soft-tissue options (hyoid place) are OSA threat components, in addition to pulmonary dysfunction, genetics and weight problems. These components could all be current for years earlier than diagnosing OSA.

Analysis of OSA begins with contemplating the affected person’s medical historical past, adopted by Epworth Sleepiness Scale and a house sleep apnea take a look at administration. The gold commonplace stays the in a single day polysomnography. The Apnea-Hypopnea Index (AHI) is the polysomnographic parameter utilized by the American Affiliation of Sleep Drugs to categorize delicate (5-15 AHI), reasonable (15-20 AHI), and extreme (>30 AHI) instances of OSA. Whereas the dental practitioner can display screen for OSA signs or threat components, a sleep medication doctor is the one who offers an correct analysis.

Present remedy for OSA entails steady optimistic airway strain (CPAP) as first-line remedy and oral equipment remedy (OAT). However, sufferers choose OATs, and studies show that lower than half of sufferers tolerate CPAP. Subsequently, the FDA has approved using OATs for delicate to reasonable instances of OSA.

OATs are typically fabricated by a dentist. Their operate is protrusion and stabilizing the mandible to realize and keep a patent higher airway throughout sleep. There are completely different classes of OATs, however mandibular development units (MADs) are primarily utilized in scientific follow and are prescribed alone. A bonus of MADs is that they scale back AHI, with roughly one-third of sufferers exhibiting full OSA decision and an AHI lower than 5 beneath this remedy. Nonetheless, research have proven comparable well being outcomes when selecting between CPAP and MAD therapies.

Furthermore, a ballot on dental sleep medication finished by the Nationwide Dental Observe-Based mostly Analysis Community (PBRN) in February 2021 demonstrated that dental practitioners face challenges in terms of screening and remedy of OSA. However on the identical time, the Nationwide Dental PBRNs ballot gave perception into the rising curiosity amongst dental practitioners taking programs in dental sleep medication. Nevertheless, OATs have a number of points, together with payors eligibility and the bridge communication between physicians and dental sleep medication specialists. Nonetheless, the sector of remedy for OSA is exponentially evolving, with extra dentists getting certified to take part and supply care to those sufferers.

~Yasmarie Santana-Rivera, Puerto Rico ’24, Digital Editor (with help from Dr. Maria Therese Galang-Boquiren, College of Illinois-Chicago, and Dr. Rahma Mungia, College of Texas Well being Science Middle)

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