What You Need to Know About Sleep Apnoea
According to some studies, 80% of patients in the US with severe Sleep Disordered Breathing (SDB) are not diagnosed. Worldwide, about 1 billion people have SDB.
SDB refers to either sleep apnoea (cessation of breathing during sleep (SA)) or sleep Hypopnea (decrease of airflow/oxygen during sleep (SH)). In both cases, a patient’s airway is either closed up or partially blocked by the tongue and uvula. Abnormal breathing during sleep leads to insufficient ventilation or cessation of breathing up to 10 sec or longer, which leads to arousals with blood oxygen desaturation. When the patient is aroused, the muscle tone of the tongue increases and the tongue moves away from the airway, so the patient can breathe in some air and fall back to sleep again. This disruptive cycle goes on and on during the night – arousal and sleep. Because of the constant arousal, a patient can never enter deep rapid eye movement (REM) sleep. REM sleep is a deep sleep that is both rejuvenating and restorative for the body.
Patients with SDB can stop breathing many times in an hour – more than 30 times an hour in severe cases.
Patients with SDB often have major health consequences: chronic headaches, increased risk of error, focus, daytime fatigue, loss of energy, loss of interest, feelings of worthlessness, depression, type 2 diabetes, glaucoma, decrease in hearing, and a decrease of libido. Besides the lower quality of life, there are also costs to society (workplace accidents, motor vehicle accidents, loss of productivity, and comorbid diseases).
A Wisconsin Sleep Study Cohort has published a paper on the mortality rate of people with sleep apnoea 18 years after they were diagnosed with the disease. It shows that 82% of the patients with moderate sleep apnoea were still alive in 18 years. But for the patients with severe apnoea, only 52% of them were still alive 18 years later. This study shows there is a significantly high mortality risk with untreated obstructive sleep apnoea (OSA), independent of age, sex, and BMI. Unmanaged Obstructive Sleep Apnoea (OSA) shortens your life.
Despite the high risk of mortality and health consequences, sleep disordered breathing has often been ignored by primary medical care. Nowadays, family physicians are more aware of the prevalence of SDB and patients who are suspected of having SDB are often referred to sleep doctors for diagnosis and therapy.
Dentists should be more involved with the screening of patients for sleep apnoea. As a matter of fact, dentists are ideal to screen, refer, manage and monitor OSA.
The treatment for OSA can be continuous positive airway pressure (CPAP) and/or oral appliances that move the jaw forward while maintaining the airway. Both are the most conservative standards of OSA treatments. However, the use of oral appliance therapy for SDB has not been commonly prescribed by medical care professionals.
Continuous positive airway pressure is the most prescribed treatment by medical professionals to treat OSA. It is considered the gold standard. Despite the proven efficacy, there is a good percentage of patients who do not want to use CPAP. There is a compliance issue. Many of them are unaware of alternative options like AutoPAP, oral appliances, and combo therapy.
40% of patients who were prescribed CPAP are non-compliant. They often cited the reason of discomfort and inconvenience of CPAP.
Oral appliance therapy (OAT) on the other hand has a 90% compliance after 2.5 years. Health outcomes are similar to CPAP, likely due to superior compliance.
Multiple studies have shown that most SDB patients who were eligible to be managed by either CPAP and OAT preferred OAT over CPAP.
Positional therapy (sleeping on the side) and weight loss are the other two additional methods. Lifestyle therapy like a reduction in alcohol, smoking etc. are other adjuncts to OSA therapy. If all else fails, surgery therapy to open up the airways is the last resort.
Tongue muscle tone therapy is the newest method under study that will keep the tongue from falling into the oropharynx and close up the airways.
All in all, OAT has been ignored by many medical professionals as the best option to treat OSA of all levels of severity. An appliance is either the journey, or it is the start of the journey to wellness.
The fact that CPAP generates aerosol continuously makes it a potential contributor to the spread of COVID-19. There has been an implication of the role of CPAP machines in spreading the disease in a nursing home in Washington State.
What are the benefits of OAT vs CPAP?
Besides the better compliance with OAT by the majority of patients, it also reduces the likelihood of contaminating surroundings with virus laden aerosols and there is ease of disinfection of the oral appliances.
Dentists need to educate themselves more on the obstructive sleep apnoea and also to ensure patients understand their options of treatment.
At Affinity Dental Care, a family dental clinic in Burlington serving Burlington, Oakville, Milton and Hamilton, we are always keeping up with the latest advancements in dentistry. We not only clean teeth and fix cavities, we also provide comprehensive treatments including implants, cosmetic bonding and veneers, root canal therapy, braces, clear aligners, crowns/bridges, sleep disorder therapy, dentures and other dental prostheses. Our goal is to provide overall wellness to our patients.