MS2 - Obstructive Sleep Apnoea Flashcards
Briefly, what are the 5 stages of sleep?
REM and non-REM stage 1-4
In general, approximately how much of the Australian population have OSA, and what is the prevalence through age groups?
approx. 5% in general
3.6-5% in 18-44
12-13% in 45+
What are some sleep disorders that a dentist and orthodontist may be able to help manage?
Sleep breathing disorders: OSA, snoring
Sleep related movement disorders: Sleep Bruxism
Does sleep apnoea pose a significant financial implication to the hospital out of all sleep-related issues.
Yes, the tx of sleep apnoea alone cost the hospital system approx. 73% out of all sleep disorders
What are some conditions that OSA increases the risk of?
- Heart failure
- MI
- schizophrenia
- depression/anxiety
- PTSD
- angina
- diabetes
what is the prevalence of snoring and is it more common in males or females?
+ Is snoring the same as sleep apnoea?
about 40% of adults - M>F
Snoring does not necessarily = sleep apnoea
What is Central sleep apnoea (CSA) vs Obstructive sleep apnoea (OSA)?
CSA - airflow ceases due to a physiological lack of respiratory drive (eg. through spinal cord injury)
OSA - airflow stops due to physical obstruction
What is Apnoea vs Hypopnea?
Apnoea - Total cessation of airflow for at least 10 seconds
Hypopnea - reduced airflow for at least 10 seconds accompanied by arousal or drop in oxygen saturation
How do you calculate severity of sleep apnoea, and what is considered mild, moderate and severe for adults vs children?
What are some symptoms of sleep apnoea?
- waking up with dry mouth or throat
- weight gain
- excessive daytime fatigue
- forgetfulness
- irritability
- poor concentration
- low mood
- restless sleep
- sexual dysfunction
- insomnia
What are some modifiable and some non-modifiable risk factors for OSA in adults?
Modifiable - Obesity, smoking, alcohol, upper airway collapsibility
Non-Modifiable - Male, Older age, Genetic factors
What are some recommendations to reduce sleep apnoea?
- weight loss
- smoking cessation
- alcohol cessation
- sleeping position (not supine)
- CPAP machine
What are some dental risk factors for OSA?
- high narrow palate
- narrow dental arches
- increased anterior face height
- increased Overjet
- Retrognathia
- Large tongue
- tonnsilar hypertrophy
What are 2 common risk factors for OSA in children?
- Enlarged tonsils and/or adenoids is the most common risk factor
- Obesity - 50% of obese children present with OSA
Differences between adults and children with OSA
Management of OSA in children and what is the biggest concern? (1, 4)
failure to thrive is the biggest concern
management:
- adenotonsillectomy
- pharmacological agents to reduce lymphoid tissue
- weight loss if obese
- CPAP
What issue can a CPAP machine cause on children?
Reports of maxillary retrusion due to continuous pressure on maxilla preventing it growing forward
what roles can the dentist play for patients with sleep apnoea?
- dentists are in a unique position to screen for sleep apnoea as they see their pts regularly
- dentists also can play a role in management through mandibular advancement appliances → should be done under the guidance of a specialist sleep physician
What are some oral signs that may suggest OSA?
- Mallampati Score - Class III or IV
- Scalloped tongue - tongue pressed against teeth during sleep - 70% OSA, also a sign of sleep bruxism
What is a questionnaire which may help in the screening of OSA?
STOP-BANG Questionnaire - 4 questions, 4 observations
A score of 3 or higher are suggestive of risk of OSA
S - snoring? is the snoring as loud or louder than talking volume
T - Tiredness - do you wake up tired, do you get tired during the day?
O - Observed Apnoeas - have you felt / has anyone told you
P - Hypertension - do you have high BP, or are you on medication for high BP?
B - BMI - overweight/obese?
A - Age - >50 years?
N - Neck circumference >40cm?
G - gender - male?
How can you screen children for signs of OSA?
- History of snoring, daytime sleepiness, difficulty concentrating, ADHD may be suggestive of OSA
- paediatric sleep questionnaire (free to download)
- Assess size of tonsils
- skeletal risk factors - Retrognathic mandible, narrow maxilla
how can sleep apnoea be diagnosed?
Polysomnography test
What does the dental therapeutic guidelines say about the management of OSA?
- dentists have an important role in the multidisciplinary management of OSA, including diagnosis of skeletal abnormalities (. eg. retrognathic mandible, narrow and high maxilla) and the construction of advancement splints
- However, the treatment needs to be done in association with a specialist respiratory physician
- Not all snoring is a sign of OSA
- Use of oral devices to treat snoring without medical investigation is not appropriate → refer for medical assessment first
- *Pts with sleep apnoea are at increased risk of respiratory arrest from sedation and GA → should be undertaken in a hospital
When is it appropriate to use Mandibular advancement splint in pts with OSA who are children vs adults?
Children - Only if there is a skeletal problem
Adults - mandibular advancement splints can be used in adults with mild to moderate OSA who don’t tolerate CPAP
considerations about Mandibular advancement devices / splints (4)
- better tolerated than CPAP
- less effective in more severe cases
- can cause changed to occlusion over time
- Adults need to be dentate for most appliances
If all other tx fails, what options can be taken?
Orthognathic surgery - maxillary and mandibular advancement surgery
