Sleep medicine and dentistry

Many health care professionals and patients are unclear of the role that dentists may play in the management of Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAHS.) The dentists’ role is primarily in the construction of appliances for OSAHS but in the United States of America some dentists have practices limited to “Sleep dentistry”. However, in the United Kingdom there is limited training for dentists in this field. This thesis aims to review the relevant literature that pertains to OSAHS and dentistry and then, through three studies, to look at the past, present and future involvement of dentists in OSAHS. Assessing outcome is clearly important and this thesis firstly presents patient-based findings of the long term success of mandibular advancement appliances. Secondly, the experience and views of dentists and sleep specialists, assessed by questionnaire, is presented. Finally, a prospective study of a promising screening tool (the Kushida Index) for the diagnosis of sleep apnoea is carried out

Evaluation of non-invasive ventilation compliance in obstructive sleep apnea syndrome or obesity hypoventilation syndrome patients: an observational study

Background: Recent times have seen the rise in obstructive sleep apnea syndrome/obesity hypoventilation syndrome (OSAS/OHS) patients across the globe. Availability of sleep study centers, questionnaires, and more awareness have made the diagnosis of OSAS/OHS early. But still, the majority of patients suffer from morbidity associated with OSAS/OHS despite the better diagnosis, the most common cause being non-adherence to (CPAP). This needs to be addressed more vigilantly and with utmost importance for successful management of OSAS/OHS.Methods: This is an observational study, we selected patients by reviewing sleep study records at a tertiary care center (Rohilkhand medical college and hospital) in Bareilly, India. All diagnosed patients with OSAS/OHS (i.e. AHI >5) were telephoned and enquired about symptoms and non-invasive ventilation (NIV) use. They were evaluated using a self-designed questionnaire.Results: In our study, we had total of 49 OSAS/OHS patients with mean age of 50.6 years and mean BMI of 35.63. Male patients were 37 (75.5%) and at the time of diagnosis AHI (mean) was 60.67 events/hour. In NIV users there were 24 patients (48.97%), 22 patients (91.7%) feel they have been benefitted from CPAP and 2 patients (8.3%) do not feel benefit from CPAP (NIV) use. Among NIV users there was significant drop of AHI (mean) to 8.07. Among NIV users there was a reduction in symptoms like excessive day time sleepiness in 18 patients (81.81%), witnessed apnea in 15 patients (88.23%), snoring in 21 patients (91.30%), blood pressure in 3 patients (21.42%), blood sugar levels in 2 patients (20%), morning headache in 5 patients (83.30%), depressive mood in 2 patients (40%), perceived memory loss in 3 patients (33.3%), sense of choking in 17 patients (94.4%) and weight loss in 19 patients (76%).Conclusions: CPAP significantly improves symptoms and provides objective as well as subjective benefit to OSAS/OHS patients but still significant proportion of patients hesitate to initiate the therapy. Poor education/awareness regarding OSAS/OHS and non-availability of affordable CPAP remains the leading cause of non-compliance. There is a need for early education, reinforcement and affordable CPAP therapy

Review of the Efficacy of Titratable Oral Mandibular Advancement Devices for the Treatment of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is prevalent throughout the United States and worldwide, and is associated with cardiovascular, pulmonary, and metabolic complications. Despite the strong evidence confining its clinical sequelae, significant barriers to clinical diagnosis and treatment of OSA exist, including under-diagnosis by medical providers and poor patient compliance with CPAP therapy-the current treatment of choice The purpose of this project was to review the literature of mandibular advancement devices (MADs) as an efficacious alternative treatment for OSA. Randomized controlled trials demonstrate that CPAP is superior in reducing the Apnea-Hypopnea Index, but MADs show a similar impact on daytime sleepiness and quality of life. Patients preferred MADs to both CPAP and surgical intervention. Authors suggest that a higher compliance with MADs likely translates into a similar adjusted AHL While no design was superior, efficacy was improved with custom fitting and mandibular protrusion. MADs titrated through the process of an overnight sleep study were equally efficacious to CPAP in moderate to severe OSA. Adjustable, titratable MADs are more successful in women, less severe disease (lower baseline AHI), lower BMl, and those who have a supine-dependent component to their OSA. Side effects are minimal and transitory. Compared with CPAP and no treatment, MADs are a cost-effective therapy in moderate OSA, but data is inconclusive Additional research on larger samples of subjects is recommended in which: a) the MAD is customized and titrated during a polysomnography in a very similar approach to fitting CPAP via an overnight sleep study, b) exclusive investigation is conducted on a specific titrntable device, and c) subjects are controlled for severity categories of OS

Sleep disordered breathing- An overview

Sleep disordered breathing has been used to describe a spectrum conditions ranging from snoring as a mild form to Obstructive Sleep apnea (OSA) which is a more severe form. Upper airway resistance syndrome falls in between the two. Oral appliance therapy and therefore dentistry has become an important component of treating patients with upper airway sleep disorders. This article places oral appliances as a treatment of choice for snoring and mild to moderate Obstructive sleep Apnea in certain patients and ahead of surgical procedures for all but the most severe patients.Key words- Obstructive sleep Apnea, Oral appliances, Upper airway resistance syndrom

The role of the nose in snoring and obstructive sleep apnoea: an update

Multilevel anatomic obstruction is often present in snoring and obstructive sleep apnoea (OSA). As the nose is the first anatomical boundary of the upper airway, nasal obstruction may contribute to sleep-disordered breathing (SDB). A number of pathophysiological mechanisms can potentially explain the role of nasal pathology in SDB. These include the Starling resistor model, the unstable oral airway, the nasal ventilatory reflex and the role of nitric oxide (NO). Clinically, a number of case–control studies have shown that nasal obstruction is associated with snoring and mild SDB. However, there is not a linear correlation between the degree of nasal obstruction and the severity of SDB, while nasal obstruction is not the main contributing factor in the majority of patients with moderate to severe OSA. Randomised controlled studies have shown that in patients with allergic rhinitis or non-allergic rhinitis and sleep disturbance, nasal steroids could improve the subjective quality of sleep, and may be useful for patients with mild OSA, however, they are not by themselves an adequate treatment for most OSA patients. Similarly, nasal surgery may improve quality of life and snoring in a subgroup of patients with mild SDB and septal deviation, but it is not an effective treatment for OSA as such. On the other hand, in patients who do not tolerate continuous positive airway pressure (CPAP) well, if upper airway evaluation demonstrates an obstructive nasal passage, nasal airway surgery can improve CPAP compliance and adherence

Adverse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome

Nasal continuous positive airway pressure (nCPAP) is now the treatment of choice for patients with sleep apnoea syndrome. Side-effects and adverse reactions have been described in isolated reports with this device. We have, therefore, systematically studied the side-effects of nCPAP therapy in 300 consecutive patients referred to the London Chest Hospital Ventilatory Support Unit. Ninety-six per cent of patients complained of at least one side-effect resulting from the therapy, with 45 per cent complaining of a side-effect specific to the nasal mask. There was no correlation between the side-effects and level of pressure used during nCPAP. The rate of compliance remained high in spite of the side-effects, with a daily use of 7.8 hours (SD 8.05) and with 83 per cent of the patients using the device every night. Although nCPAP treatment remains acceptable to most patients there exists a high incidence of adverse effects

PAP treatment in patients with OSA does not induce long-term nasal obstruction.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadWe hypothesized that positive airway pressure treatment would induce nasal obstruction and decrease nasal cavity due to mucosal swelling. We further hypothesized that subjective and objective nasal obstruction at baseline would negatively affect positive airway pressure adherence. A total of 728 patients with sleep apnea were investigated in the Icelandic Sleep Apnea Cohort at baseline and 2 years after starting positive airway pressure. Patients underwent home sleep apnea testing at baseline. Questionnaires were answered and acoustic rhinometry was completed at baseline and follow-up. The proportion of patients reporting subjective nocturnal nasal obstruction was reduced (baseline: 35% versus follow-up: 24%; p < 0.001). Small interior nasal dimensions increased (p < 0.001) independent of adherence to treatment. Small nasal volume at baseline was a determinant for becoming a non-user of positive airway pressure treatment (odds ratio 2.22, confidence interval 95% 1.35-3.67, p = 0.002). Subjective nasal obstruction decreased 2 years after initiating positive airway treatment in sleep apnea, and objectively small nasal dimensions increased. Small nasal volume at baseline was a negative predictor for positive airway pressure treatment adherence. Maybe most importantly, positive airway pressure treatment did not cause long-term objective or subjective nasal obstruction.United States Department of Health & Human Services National Institutes of Health (NIH) - USA ACTA from Region Skane FoU from Region Skan

Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea

What is OSA-Consequences of untreated OSA CPAP Therapy Why do we need alternatives to positive airway pressure (PAP) therapy How do we evaluate for alternative treatments Who is a candidate What are the alternative

Nocturnal nasal obstruction is frequent and reduces sleep quality in patients with obstructive sleep apnea.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesThe prevalence and consequences of nasal obstruction in untreated obstructive sleep apnea patients are not known. The study objectives were to investigate the frequency of subjective and objective nasal obstruction in untreated sleep apnea patients and the associations with sleep and quality of life. Patients in the Icelandic Sleep Apnea Cohort were subjected to a type 3 sleep study, answered questionnaires and had their nasal dimensions measured by acoustic rhinometry. In total, 810 patients participated (including 153 females), aged 54.5 ± 10.6 years [mean ± standard deviation (SD)] with an apnea/hypopnea index 44.7 ± 20.7 h-1. Nocturnal nasal obstruction (greater than or equal to three times per week) was reported by 35% of the patients. These patients had smaller nasal dimensions measured by the minimum cross-sectional area within the smaller nasal valve (0.42 ± 0.17 versus 0.45 ± 0.16 cm2, P = 0.013), reported more daytime sleepiness (Epworth Sleepiness Scale score 12.5 ± 4.9 versus 10.8 ± 5.0; P < 0.001) and slightly lower mental quality of life than patients without nocturnal nasal obstruction. Nocturnal nasal obstruction is reported in one-third of the sleep apnea patients and they are more likely to suffer from daytime sleepiness and slightly reduced quality of life than other sleep apnea patients.NI