Obstructive sleep apnea Flashcards
_____ sleep apnea: absence of airflow despite
respiratory effort- Dentist may treat
Obstructive sleep apnea
_____ sleep apnea: absence of airflow & No respiratory
effort (brain control of respiration is
abnormal) –
treated by M.D. with
medications
Central sleep apnea
Diagnosis of _____ MUST be made by a
licensed physician (NOT a dentist) & a
Polysomnogram (PSG) sleep study must be
ordered by the M.D. as well as treatment
studies.
2. Requires a National Provider Identification
Number (NPI) and dental license to bill for
this medical condition
3. Requires advanced training to TREAT &interpret the sleep studies to determine
efficacy of sleep appliance.
Obstructive sleep apnea
- Is not treated in the pre-doctoral or resident
clinics - Can be treated by general dentists who are
certified in sleep medicine with knowledge
of Medical Billing. CE coursework is required
to treat
Obstructive sleep apnea.
is a very common and potentially
life-
threatening medical disorder (i.e. heart
attack, stroke)
occurs when tissue in the back of the throat
collapses and blocks the airway, reducing the
amount of oxygen delivered to all of your
organs including your heart and brain
Obstructive sleep apnea
cessation of oronasal airflow for > 10
seconds
Apnea-
- decrease in airflow of 50% for
>10 seconds with >3% O2 desaturation
Hypopnea
the average number of
apneas and hypopneas per hour of sleep (AHI)
Apnea-Hypopnea Index:
HOw many AHI requires tx?
5 or more
What is the normal SaO2?
> 93%
What desaturation in OSA is 85-89%?
MIld
What desaturation in OSA is 80-84%?
Moderate
What desaturation in OSA is <80%?
Severe
What is the most common thing to occur in low oxygen levels?
A fib
Are males or females more at risk for OSA?
Males
If a pt has class 1 soft palate, how is airway?
Well open
If a pt has class 4 soft palate, how is airway?
No airway space
- Is REQUIRED by insurance prior to treatment
(pre-treatment), M.D. must order PSG - Is REQUIRED at end of completion (post-
treatment) to determine efficacy of oral
sleep apnea appliance although some
insurance will accept the home sleep study - May be ordered while titrating appliance or
a home sleep study may be authorized
Polysomnography (PSG)
The following are ___ for sleep devices
1. Insufficient teeth to support device however
can be made if 1 arch is edentulous
2. Periodontal problems causing tooth mobility
3. Active temporomandibular joint disorder
(TMD) or severe arthritis
4. Limited maximum protrusion < 6mm
Clark GT. Mandibular advancement devices and sleep disordered
breathing.
Contraindications
Splints the upper airway pneumatically during
sleep so airway does NOT collapse
Highly effective but cumbersome
Long-term compliance is 60 – 70%
CPAP: Continuous positive airway pressure
Surgical removal of uvula with resection of
soft palate tissue to create more space
50% of patients report improved sleep apnea
symptoms but not always long term
Surgery to correct deviated septum, nasal
polyps, tonsillectomy and chronic rhinitis may
also help
Uvulopalatopharyngoplasty
Oral applicances are best for what levels of OSA?
MIld/MOdereate
MOA of _____
1. Normally made 50-75% of the maximum
protrusion
2. Widening of the airway laterally
3. Relocation of the pharyngeal fat pads
laterally
4. Anterior displacement of the tongue base
5. Protrusion is normally accompanied with
increased vertical dimension
Custom oral appliance
Has nylon advancement rods that patient can
change at home
Less driving and less appointments needed
No metal
Avant sleep apnea device
