Obstructive sleep apnoea: A review of the orofacial implications

The document attached has been archived with permission from the Australian Dental Association (8th Jan 2008). An external link to the publisher’s copy is included.Obstructive sleep apnoea is a complex multifactorial condition produced by a combination of anatomical and physiological factors. There is a significant associated mortality and morbidity to obstructive sleep apnoea. There is an at least 25 per cent increased mortality from cardiovascular disease when obstructive sleep apnoea patients are compared to age and gender matched healthy people. Obstructive sleep apnoea sufferers also have a much higher industrial and motor vehicle accident rate. Management of the condition should be undertaken by a multidisciplinary team including respiratory physicians, sleep laboratory technicians, otorhinolaryngologists, oral and maxillofacial surgeons and dental specialists. The diagnostic and therapeutic interactions of team members are the key to successful treatment. The treatment regime utilises nasal continuous positive airway pressure devices, mandibular advancement splints and soft and hard tissue surgery. This review provides the dental practitioner with an introduction to obstructive sleep apnoea with particular emphasis on the orofacial aspects.David Sherring, Norman Vowles, Ral Antic, Suren Krishnan and Alastair N Gos

An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?

The definitive version is available at www.blackwell-synergy.comRationale, aims and objectives Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1–7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3–7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention.Adam G. Elshaug, John R. Moss, Anne Marie Southcott and Janet E. Hille