W6 - Sleep Opnoea - Abdalla

Question 1

Describe the sleep cycle

Answer 1

Stage 1 - light sleep “twitches, jerking”

REM - first occurs after 90 min, then every 90 min thereafter

Stage 2 - brainwaves slow, assoc w/ memory consolidation

Stage 3+4 final and deepest stages of sleep

REM gets longer through the night

Deep sleep reduces through the night

Question 2

Sleep disorders (6)

Answer 2

Insomnia

Parasomnia (sleep walking, talk, etc)

Sleep-related breathing disorders (OSA, snoring)

Sleep-related mvmt disorders - nocturnal bruxism

Narcolepsy

Circadian rhythm sleep disorders (jet lag)

Question 3

What other chronic conditions can be worsened by OSA (4)

Answer 3

Increased risk of developing:

Heart failure

Heart attack

Schizophrenia

Anxiety/depression

Question 4

What causes snoring in adults

Answer 4

Vibration of loose soft tissues in the airway as air passes over them

Question 5

What causes snoring in children

Answer 5

Enlarged tonsils or adenoids

Question 6

Snoring = sleep apnoea?

Answer 6

No

Question 7

How does sleep apnoea get subclassified

Answer 7

Central sleep apnoea (CSA)

Obstructive sleep apnoea (OSA)

Complex (combination)

Question 8

Features of central sleep apnoea

Answer 8

Airflow ceases due to a temporary lack of inspiration

CNS issue

• Polymyelitis
• Spinal cord injury
  
  • Encephalitis

Question 9

Apnoea vs hypopnea

Answer 9

Hypopnea - reduced airlow for at least 10s, accompanied by arousal or drop in o2 sat

Apnoea - Total cessation of airflow for at least 10s

Question 10

Central sleep apnoea vs obstructive sleep apnoea

Answer 10

CSA = CNS issue

OSA = physical obstruction of airway

Question 11

Describe severity of apnoea for children and adult ranges

Answer 11

Question 12

Describe the pathophysiology cycle of OSA

Answer 12

Question 13

How does apnoea affect the sleep cycle and lead to symptoms?

Answer 13

Patients are unable to complete the sleep cycle - keep getting woken up

• 27 min in

Question 14

Symptoms of sleep apnoea (8)

Answer 14

Poor concentration

Low mood

Restless sleep

Heartburn

Waking up in the morning with dry mouth

Night sweats

Weight gain

Daytime fatigue

Question 15

Modifiable risk factors of OSA adult

Answer 15

Obesity

Smoking

alcohol

Upper airway collapsibility

Question 16

How can lifestyle be modified to reduce OSA (4)

Answer 16

Weight management

no drinking/smoking

sleeping position alteration (not supine)

CPAP

Question 17

Describe the comorbidities of OSA (4)

Answer 17

Hypertension

CVD

Stroke

Metabolic syndromes

Question 18

Dental risk factors of OSA (7)

Answer 18

High narrow palate

Narrow dental arches

Increased anterior face height

Increased overjet

Retrognathia

Large tongue

Tonsillar hypertrophy

Question 19

Why doesnt CPAP work very effectively in adults?

Answer 19

Poor pt compliance

Question 20

Differences btw adult and children OSA

Answer 20

Question 21

Concern with CPAP machine use in children

Answer 21

Hypomaxillary development

Class 3 / midface def

Question 22

Management of OSA children (4)

Answer 22

Adenotonsillectomy

Pharmacological agents to reduce lymphoid tissue

Weight loss if obese

CPAP (caution - maxillary retrusion)

Question 23

Why is assessing OSA important for dentists? (4)

Answer 23

• Under diagnosed and reported - GP’s dont screen for it
• Dentists see their pts regularly
• Dentist can manage pts with provision of mandibular advancement devices
• Should always be done under guidance of specialist sleep physician

Question 24

How to screen adults (mallampati score) for OSA

Answer 24

Question 25

How to screen adults for OSA using STOP BANG questions

Answer 25

Question 26

What anatomical feature to screen for OSA

Answer 26

Scalloped tongue

• 70% diagnostic for OSA
• Also sign of nocturnal bruxism
• Tongue presses up against teeth during sleep

Question 27

3 ways of screening adults of OSA

Answer 27

1. Check for scalloped tongue
2. STOP-BANG questionnarie
3. Mallampati Score

Question 28

How to screen children for OSA (5)

Answer 28

Epworth Sleepiness Scale

Paediatric sleep questionnaire

History of snoring, daytime sleepiness, ADHD

Brodsky scale for enlarged tonsils

Skeletal risk factors (narrow mx, mandibular retrognathia)

Question 29

What is the only way to truly diagnose OSA

Answer 29

Dentists can’t do it - we can only screen

Polysomnogram / Polysomnography test

Question 30

TG advice on how to manage OSA (4)

Answer 30

Diagnosis of facial skeletal retrusion (retrognathia)

Refer for medical examination and sleep lab investigation

Construction of md advancement splints BUT must be done in association with a multidisciplinary team led by resp specialist physician

Be mindful of GA - OSA pts are at increased risk of respiratory arrest with GA and sedation - do it in hospital if required

Question 31

Consideration of sedation and GA for dental treatment in OSA pts

Answer 31

increased risk of respiratory arrest

• treat in hosp if required

Question 32

What is the role of the dentist/ortho in tx of OSA (3)

Answer 32

• Skeletal problems causing malocclusion should be corrected (RME, functional appliance, etc) in adults
• Mandibular advancement splints to be used in adults with mild-mod OSA who cannot tolerate CPAP
• Bimax protrusion orthognathic surgery if all else fails

Question 33

Should ortho appliances and mandibular advancement splints be used to treat OSA in children?

Answer 33

No - insufficient evidence

Question 34

Features of mandibular advancement splints for OSA (4)

Answer 34

• Better tolerated than CPAP
• Less effective in severe cases
• Can cause changes to occlusion over time
• Adults need to be dentate for most appliances

Question 35

Risk factors for smaller upper airway in children (2)

Answer 35

Narrow maxilla

Mandibular retrognathia

Class 2

Question 36

What is the Brodsky scale for enlarged tonsils in kids

Answer 36