Snoring and Sleep Apnea
Approximately 40% of adults over 40 snore. Snoring is the vibration of soft tissues as air passes through an airway that is too small to allow for smooth, unimpeded flow. Snoring can be a sign of a more serious problem, Obstructive Sleep Apnea (OSA). OSA is characterized by 90% blockage of airflow during breathing for at least 10 seconds at a time.
Consequences
Untreated OSA can contribute to high blood pressure, stroke, arrhythmias, heart attack, excessive daytime sleepiness, motor vehicle and workplace accidents, poor job performance, decreased quality of life and more.
Clinical Signs and Symptoms of OSA
Snoring
Excessive Daytime Sleepiness
Awakenings with gasping or choking
Fragmented, non-refreshing, light sleep
Poor memory, clouded intellect
Irritability, personality changes, depression
Decreased sex drive, impotence
Frequent nighttime urination
Morning headaches
Gastro-esophpageal reflux (GERD)
Risk factors for OSA
Obesity
Increasing age
Male gender
Anatomic abnormalities of the upper airway
Family history
Alcohol or sedative use
Smoking
Diagnosis of OSA
Screening questionnaires are helpful for likelihood of moderate to severe apnea, but a negative result does not mean that you don’t have OSA. If you snore, are more tired than you think you should be, have any associated symptoms or medical condtions you should get tested for OSA to avoid consequences.
Polysomnography – In-lab sleep study with multiple electrodes attached to the patient and observed overnight by a technician. Done less often as Home Sleep Tests have become more efficient.
Home sleep study – range from pulse oximetry to more complex devices such as the ARES home sleep test which can measure almost everything that a sleep lab test can do in the comfort of the patient’s own bed.
Treatment
Surgery – maxillomandibular surgery – advances the jaws(s) surgically, or Uvulopalatopharyngoplasty (UPPP) removes the posterior portion of the soft palate. Success rate is approximately 50%.
CPAP or APAP machines deliver room air under pressure through the nose using a nasal mask. This is 100% effective in treating apnea and the treatment of choice for moderate to severe OSA.
Oral appliances, which advance the mandible, are used to prevent the soft tissues and base of tongue from collapsing and obstructing the upper airway. These are indicated for use to treat mild or moderate OSA. Or for patients who can’t or won’t use CPAP therapy.
Oral Appliance Therapy
Diagnosis – medical diagnosis must precede appliance therapy
Indications – primary snoring, selected patients with OSA, CPAP intolerance, surgical contraindications
Appliance fitting – appliance selection and fitting by specially trained dentist
Follow-up – Follow up test and periodic evaluation by dentist
Get screened and tested if you snore or are more tired than you think you should be. Untreated OSA can have serious health consequences.