Sleep Apnea Flashcards
Definition of Sleep related breathing disorders:
Apnea: no airflow 10 sec +
Hypopnea: reduction of airflow, and Oxygen desaturation of >= 4%
Apnea-hypopnea index (AHI): Avg frequency of apnea / hypopnea events per hour of sleep
Obstructive sleep apnea: AHI of 15 or more, or 5 or more associated symptoms
Central sleep apnea: AHI of 5 or more, or more than half of respiratory events occuring without any inspiratory effort.
Male Female ratio of sleep apnea:
Males > Females before 50 yrs
Male = Female after menopause
What kind of people have OSA?
70% of obese - Large neck size
Pts with heart disease 30–50% - family history of apnea
Pts with strokes, 60% - GERD
14% of nfl players and 34% of nfl linemen - nasal obstruction, deviated sept.
African americans 2.5x than caucasions
Sleep apnea can cause…
TMJ: disorder in jaw muscle
Sleep Burxism (teeth grinding): headaches
Mouth breathing - leads to tooth decay, plaque, gingivitis
% of ppl with hypertension that have sleep apnea
30-83% of patients with hypertension have sleep apnea
43% of patients with mild OSA and 69% of patients with severe OSA have hypertension
Central sleep apnea caused by…
Obstructive sleep apnea caused by…
Central sleep apnea is caused by a failure of brain to activate muscles of breathing during sleep
Obstructive sleep apnea is caused by collapse of airway during sleep
explain the pathophysiology of OSA:
When you sleep, your tongue relaxes on oropharynx which blocks airway. The negative pressure in the lungs suck the air in making this worse. This signals brain to wake up so air can pass.
Identify manifestations of OSA:
many things…. insomnia snoring dry mouth memory loss nocturia depression… stroke heart attack arrythmeia lung hypertension diabetes drowsiness obesisty… bla bla bla
Describe diagnostic techniques applied to OSA:
Subjective methods and Objective methods
Subjective methods:
Epworth sleepiness scale (0-24 of how sleep you are)
Self report test to establish severity
Medical history
Objective methods:
Polysomnography (sleep study)
Multiple sleep latency
Maintenance of wakefulness sleep
Polysomnography: which parameters are measured? Which is a key to differentiate between CSA and OSA?
Respiratory effort: chest and abdominal movement.
Identify screening OSA risk factors, extra and intraoral features:
extraoral features: 17 inch or more neck for males, 16 females
Retrognathic profile (severe overbite)
Class II malocclusion (overbite)
Long face
Small nasal pathway
Intraoral: Macroglossia (big tongue)
Elongate soft palate, a lot more
Role of dentist in OSA:
Screen patients for OSA risk factors
Referral to appropriate health professional
Providing oral appliance therapy followed by regular dental and sleep medical follow-up.
Dentist Role: Screening OSA Risk factors. What are some of the risk factors?
Retrognathia (abnormal mandibular)
High arched palate
Enlarged tonsils / tongue
Enlarged Tori (the bump on roof of ur mouth)
High Mallampati score (assessment describing relative size of base of tongue compared to mouth opening)
Oral appliances in OSA:
Oral device placed on teeth, holds jaw and tongue forward and palate up preventing closure of airway
Surgical options for OSA:
Palate implants
Uvulopalatopharyngoplasty: surgery taking out extra tissue in throat
Genioglossus advancement: surgery where you pull base of tongue forward
Maxillomandibular procedures
Combinations of above
