Obstructive Sleep Apnea (OSA)

Of the general adult population in middle age, 93% of women and 82% of men with moderate to severe sleep apnea syndrome have not been clinically diagnosed 1. Sleep apnea is even less likely to be diagnosed in the older population. Unrecognized sleep-disordered breathing is linked to motor vehicle accident occurrence in the general population and may account for a significant proportion of motor vehicle accidents 2. Dentistry can play an important role in the recognition and treatment of this disease continuum in cooperation with your physician(s).

image001Normal Breathing

When you breathe normally, air passes through the nose and past the flexible structures in the back of the throat such as the soft palate, uvula and tongue. While you are awake, muscles hold the airway open. When you fall asleep, these muscles relax but, normally, the airway stays open.

Obstructive Sleep Apnea

When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. People with apneaobstructive sleep apnea (OSA) have disrupted sleep, and low blood oxygen levels. OSA has been associated with cardiovascular problems and excessive daytime sleepiness 3. The condition Upper Airway Resistance Syndrome (UARS) lies midway between benign snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA, but normal sleep testing will be negative.

Working with your physician

Since snoring is so common, both the medical profession and the public have regarded it merely as a source of humour or as an annoyance to be sleeping beside someone who snores 4. Snoring is one stage of a complex continuum of disease states culminating in obstructive sleep apnea. Understanding the complicated pathophysiology of obstructive sleep apnea is essential to proper treatment and underscores the necessity of dentist-physician interaction.

The consequences of undiagnosed and incompletely treated sleep apnea are serious and medical in nature. In addition to an increased rate of motor vehicle accidents among the sleep apneic population, systemic hypertension has been reported in up to 50% of patients with sleep apnea. In fact, average morning blood pressure has been shown to increase with the increasing severity of obstructive sleep apnea in both obese and non-obese patients 5. Dr. Merrell regularly consults with sleep physicians in order to more completely understand our role as members of the treatment team.

Merrell Clinic is pleased to participate in the treatment of a potentially life-endangering disease and we cooperate with colleagues in the medical community as part of your treatment team.

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Sources

 

1. Young Am. J. Resp. Criti Care Med 2002

2. Tregar J. Clinicla Sleep Med 2009

3. Malhotra Lancet Resp. Med. 2015

4. Virkkula Chest 2005

5. Dean, Redline Sleep 2015