3- Obstructive Sleep Apnea For the General Dentist

Question 1

What are 2 divisions of normal sleep stages?

Answer 1

1.) Nonrapid eye movement sleep (NREM)
2.) Rapid eye movement sleep (REM)

Question 2

What are the progressions of normal sleep?

Answer 2

Wakefulness -> NREM -> REM

Question 3

T or F, 75-80% of our sleep progression is in NREM sleep & 20-25% of our sleep is in REM sleep

Answer 3

True

Question 4

What does the N1 stage encompass in the NREM stages of normal sleep?

Answer 4

Mixed frequency sleep
(a.k.a drowsy or light sleep)
by which people may experience sensation of falling

Question 5

What does the N2 stage encompass in the NREM stages of normal sleep?

Answer 5

• The beginning of deeper sleep
• still easily aroused
• 45-55% of all sleep

Question 6

What does the N3 stage encompass in the NREM stages of normal sleep?

Answer 6

• “slow-wave” sleep
• Deeper than stages of N1 & N2
• Known as restorative sleep

Question 7

What is normal REM sleep?

Answer 7

It is known as the “dream sleep” which encompasses 20-25% of all sleep

• each successive cycle of REM sleep gets deeper & deeper

Question 8

What are the 6 important airway anatomy?

Answer 8

1.) Tongue
2.) Soft palate
3.) Oropharynx
4.) Hyoid
5.) Pharynx
6.) Supplementary muscles

Question 9

What airway has the role in mastication, swallowing & taste?
(hint: have intrinsic & extrinsic muscles)

Answer 9

The tongue

Question 10

What airway has a role in swallowing, & breathing & aids to close the soft palate?

Answer 10

The soft palate

includes:
Tensor veli palatini
Palatoglossus
palatatopharyngeus
Levator veli palatini
Musculus uvulae

Question 11

What airway is found at the posterior aspect of the airway & tongue?

Answer 11

The oropharynx

Question 12

What airway has both the suprahyoid & infrahyoid muscles, & is to help elevation & widening during swallowing

Answer 12

The hyoid

Question 13

What airway is unsupported, & subject to narrowing or collapse?

Answer 13

The pharynx

Question 14

What muscles are considered supplementary to other airways?

Answer 14

1.) Masseter, temporalis, pterygoids, anterior & posterior cervical group

Question 15

How can we define respiration?

Answer 15

It is an involuntary movement by which controls the diaphragm (innervated by the phrenic nerve)

Question 16

What are the 2 types respiration movements?

Answer 16

1.) Passive inspiration
2.) Passive expiration

Question 17

How can we define passive inspiration?

Answer 17

It is the diaphragm that contracts & moves downward, leading to negative pressure within lung, allowing air to come in.

Question 18

How can we define passive expiration?

Answer 18

It is the elastic recoil of lungs forcing out.

Question 19

What can be the correlation of pain & sleep?

Answer 19

• That people have difficulty sleeping with chronic pain.
• That they may have often shorter sleep duration as well as poorer quality sleep
• can lead to microarousals during bed, more difficult to achieve deeper levels of sleep

Question 20

What is obstructive sleep apnea?

Answer 20

It is the most common form of sleep disordered breathing (SDB)

Question 21

How is Obstructive Sleep Apnea manifested? what can it lead to ?

Answer 21

It is due to the collapse of upper airway due to the relaxation of muscles that control the tongue & soft palate. It can lead to reduced airflow & subsequent apneas & hypopneas

Question 22

How is apnea defined as?

Answer 22

The cessation of airflow for > 10 seconds

Question 23

How is hypopnea defined as?

Answer 23

It is a decrease in airflow lasting > 10 seconds, with a 30% oxygen reduction in airflow with atleast 4% oxygen desaturation from baseline.

Question 24

What occurs in the airways in snoring?

Answer 24

There is a PARTIAL obstruction of the airway

Question 25

What occurs in the airways in obstructive sleep apnea?

Answer 25

There is a complete obstruction of the airways

Question 26

What are the risk factors associated for Obstructive Sleep Apnea?

Answer 26

1.) Obesity
2.) Anatomical variation
3.) Retrognathia
4.) Genetics
5.) Ethnicity
6.) Syndromes:
- Down Syndrome
- Asperger Syndrome
- Pierre Robin Syndrome

Question 27

What are some of the signs & symptoms of OSA for children during the night time?

Answer 27

1.) Snoring
2.) Bruxism
3.) Awakening
4.) Mouth breathing
5.) Nightmares

Question 28

What are some of the signs & symptoms of OSA for children during the daytime?

Answer 28

1.) Neurocognitive impairment
2.) Hyperactivity
3.) Irritability
4.) Poor school performanc

Question 29

What are the signs & symptoms of OSA for adults?

Answer 29

1.) Lack of energy (fatigue)
2.) Hypertension
3.) Depression
4.) Obesity
5.) Morning headaches
6.) Gasping for air
7.) Gastroesophageal reflux (GERD)
8.) Snoring

Question 30

What are some of the Medical conditions Related to OSA for children?

Answer 30

1.) Depression
2.) Enuresis
3.) Asthma
4.) Type II diabetes
5.) Irritable/ADHD
6.) Allergy
7.) Headaches
8.) Obesity

Question 31

What are some medical conditions related to OSA for adults?

Answer 31

1.) Drug-resistant hypertension
2.) obesity
3.) Congestive heart failure
4.) Diabetes (type II)
5.) Elevated triglycerides
6.) Coronary artery diseases

Question 32

What are some dental conditions related to OSA?

Answer 32

1.) Swollen or enlarged tonsils
2.) High, arched palate
3.) Orthodontic concerns
4.) Myofascial pain
5.) Scalloped tongue
6.) TMD
7.) Tooth attrition

Question 33

What is the significance of having a HIGHER tonsil score?

Answer 33

HIGHER tonsil score = HIGHER risk of sleep apnea

Question 34

What is the most frequent symptom of OSA occurring in patients? (hint: more prevalent in men)

Answer 34

Snoring

Question 35

What are the four important signs/symptoms of obstructive sleep apnea?

Answer 35

1.) Habitual snoring
2.) Excessive daytime somnolence
3.) Body mass index (BMI) > 35kg/m2
4.) Observed, witnessed apneas

Question 36

What are the 3 types of screening for Obstructive Sleep Apnea?

Answer 36

1.) Epworth sleepiness scale
2.) STOP - Bang
3.) PSQ - Pediatric sleep questionnaire

Question 37

What does the Epworth sleepiness scale measure?

Answer 37

It measures the daytime sleepiness.
A score out of 24
Where 0-9 = normal
10-24 = medical advice should be sought

Question 38

What does the STOP- Bang questionnaire ask & measure?

Answer 38

1.) Snoring
2.) Tired
3.) Observed
4.) blood Pressure
5.) BMI
6.) Age
7.) Neck
8.) Gender

Yes to 3 or more Q’s = HIGH risk
Yes to less than 3 Q’s = LOW risk

Question 39

How does the PSQ (Pediatric sleep questionaire) assess risk for OSA in children?

Answer 39

Assesses it with questions related to child’s sleep patterns & habits

Question 40

How is OSA diagnosed?

Answer 40

With Polysomonography (PSG) a gold standard & tool used in sleep medicine to diagnose or rule out different sleep disorders.

Question 41

How is a PSG (polysomonography) used?

Answer 41

It is used my monitoring simultaneous & continuous data of:
1.) Brain wave activity
2.) Eye movements
3.) Muscle activity of legs & mandible
4.) Body position
5.) Heart rate & rhythm
6.) Snoring
7.) Respiratory activity that includes breathing patterns & oxygen saturation.

Question 42

How is grading of OSA conducted?

Answer 42

It is based on the apnea-hypopnea index (AHI), which represents the number of apnea & hypopnea events per hour.
- <5 AHI = normal
- 5-15 AHI = mild OSA
- 15-30 AHI = moderate OSA
- > 30 AHI = severe OSA
* For children, an AHI>1 is considered normal

Question 43

What are some OSA treatments?

Answer 43

1.) Weight loss
2.) Avoiding alcohol or medications depressing the CNS
3.) Positional therapy
4.) Myofunctional therapy
5.) CPAP
6.) Oral appliances
7.) Orthognatic surgery

Question 44

What are examples of oral appliances that could help treat OSA?

Answer 44

1.) Mandibular repositioning appliances
2.) Tongue retaining devices