Oral Appliance therapy for snoring and obstructive sleep apnoea Flashcards
What is obstructive sleep anpoea?
Apnoea is Cessation of airflow for >=10 seconds
Obstructive sleep apnoea is repetitive episodes of complete or partial airway obstruction during sleep resulting in teh cessation of airflow despire continuing resp efforts
What is hypopnoea?
Reduction of airflow with associated reduction in SaO2 and/or arousal from sleep
What are respiratory effort related arousals?
Episodes of drop in inspiratory airflow, increased inspiratory effort and a brief arousal that do not meet criteria for apnoea or hypopnoea
What is upper airway resistance syndrome?
Diagnosed by observations of increased respiratory effort assocaited with abormal breathing pattern that does not meet the criteria for hypopnoea
What is central sleep apnoea?
Cessation of airflow during sleep in absence of obstruction or resp efforts
What is the AHI?
Apnoea - hypopnoea index
Calculated by (A + H)/hours of sleep
What are the signs and symptoms of OSA?
Snoring
Daytime sleepiness
Gasping/choking
Unrestorative sleep
Concentration and memory changes
Dry mouth
Restless sleep
Reflux
Mood and depression
Insomnia
Libido and erectile dysfunction
Personality changes
What are the cardiovascular, metabolic, and neurocognitive effects of obstructive sleep apnoea?
CVS: Incident hypertension
Prevalent coronary artery disease
Incident stroke
Metabolic: Prevalent impaired fasting glucose, prevalent diabetes
Neurocognitive: Motor vehicle accidents, occupational accidents, and incident depression
Mortality: increased all cases and cardiovascular
How is OSA diagnosed?
Through a sleep study and scoring sleep
How is OSA treated?
LIfestyle modification for weight loss
CPAP
Oral appliances
Surgery
What are the types of oral appliances?
Tongue retaining device (holds tongue in forward position)
Mandibular advancement device (holds mandible forward)
What are the indications for oral appliances for OSA?
Patients who prefer OA to CPAP
Do not respond to CPAP
Are not appropriate candidates for CPAP
Fail treatment attempts with CPAP
What are the guidelines for treatment of OSA with oral devices?
Sleep physisician must prescribe OAT rather than no treatment for snoring
OAT to be prescribed by qualified dentist and use custom, titratable oral device
Recommend treatment with oral device rather than no treatment for patients intolerant of CPAP
Must do a follow up study to monitor effects and occlusal changes
Sleep physician must conduct treatment sleep study after OAT to assess efficacy.
Need for long-term followup
What factors improve the prediction of outcome of OATs?
Females better than males
Lower age = better
Low BMI (<30)
Smaller neck circumference
Lower AHI
Supine-dependent OSA do better
Low nasal resistance do better
What factors make the prediction of outcome of OATs worse?
Obese
Severe OSA
Nasal resistance/obstruction; mouth breather
Non-positional OSA
What are the contraindications for MADs?
Severe perio disease
Severe TMJ disorders
Inadequate number of teeth
Inadequate crown height
Growing children
Severe gag reflex
Claustrophobia
Inadequate protrusive movement capability
Lack of coordination and
What are the types of MADs?
Prefabricated (boil and bite)
Non-adjustable devices (no longer done anymore
Adjustable appliances
What are the side effects of MADs?
Occlusion changes
TMJ pain
Masseter muscle pain
Headache
Jaw discomfort
How is success defined for oral appliances?
Reduction in snoring
Waking more rested
Less sleepy during the day
Reduction in AHI <50% from baseline, reduction to less than 5, 10 or 15 different doctors have different criteria
Normalisation of oxygen saturation
How successful is oral appliance therapy in OSA patients/
60% approximately
How do outcomes of CPAP compared to mandibular advancement device?
CPAP better improvement
MAD preferred over CPAP
Efficacy + compliance = effectiveness
Both MAD and CPAP may be equally effective in reducing risk of fatal CVS in severe OSA
