Screening for Sleep Apnea in a Dental Setting
Obstructive sleep apnea is a medical condition receiving escalated attention due to its associated dangers that range from systemic diseases to fatigue-related accidents. Approximately 5.9 million United States adults are diagnosed with this condition, whereas an estimated 23.5 million cases remain undiagnosed. This public health issue calls for dental professionals to increase their familiarity with obstructive sleep apnea, and implement screening protocols and an interprofessional approach to patient care.
Risk factors include age, obesity, gender, hormones, pregnancy, and lifestyle. Prevalence increases with age and plateaus after 60. Obesity affects a large number of individuals with obstructive sleep apnea. A common characteristic of obesity is excess adipose tissue in the head and neck region that contributes to airway obstruction.
Due to differences in anatomy and physiology, sleep apnea is more common in men than women. Hormonal changes are associated with prevalence; for example, compared with premenopausal women, a larger number of post-menopausal women have been diagnosed with this condition. Post-menopausal women who do not use hormone replacement therapy are at increased risk. Pregnant women have increased risk, especially during the third trimester when weight gain is greatest.
Symptoms can manifest when the patient is sleeping or awake. Smoking can cause an inflammatory reaction of the pharynx that reduces the airway; similarly, alcohol and sedative use can reduce muscle activity, worsening the symptoms. When sleeping, affected individuals may experience nonrestorative sleep characterized by feelings of insufficient rest. Choking, insomnia, restlessness, unsettling dreams, gastroesophogeal reflux, nocturia, drooling, and excess perspiration are also reported symptoms. Affected individuals may complain of excessive daytime sleepiness.
Continuous positive airway pressure (CPAP) is the gold standard for treatment, especially in more severe cases. Use of a CPAP facemask improves quality of life, daytime sleepiness, cognitive function, and blood pressure. One of the main issues with this treatment is a lack of patient compliance.
Although oral health professionals cannot diagnose obstructive sleep apnea, they play an integral part in screening for sleep related breathing disorders and the fabrication of oral appliances to treat the disorder. Oral appliances are the treatment option most suitable for mild-to-moderate cases. Most commonly used are mandibular-repositioning devices designed to hold the mandible in a forward position, enlarge the area posterior to the tongue, and reduce collapse of the pharynx and palate. Tongue-retaining devices are splints that hold the tongue in place to maintain an open airway.
If you think you may have sleep apnea, take the STOP-Bang Questionnaire Visit your dentist and dental hygienist for more information.