Snoring and Sleep Apnea

 

The following information is part of an article by  W. Keith Thornton, Associate Faculty at the Pankey Institute.

Recent articles and advertisements in professional and lay literature promote the use of oral devices as a treatment for snoring and obstructive sleep apnea. In response to patient needs, dentists have expanded their practices to treat sleep disordered breathing. In order to best treat the patient and achieve maximum success, it is imperative for both the dentist and the patient to have a firm understanding of the disorder being treated.

The Pankey Institute is the premiere institute in the field of sleep disordered breathing and oral appliances. Dentists trained at the institute are knowledgeable of the medical implications of oral appliance therapy and have a knowledge of the diagnosis and treatment of the condition. They have been taught how to work with the medical community and to achieve the best results for their patients.

Definitions

Snoring and sleep apnea represent opposite ends of a continuum that describes sleep disordered breathing. Although snoring is medically benign, it is perhaps the best fire alarm for a more severe medical condition, obstructive sleep apnea. Both result from the inappropriate collapse of soft tissue and the tongue into the pharynx during sleep.

Snoring occurs when a partial collapse in the throat causes vibration of the soft tissue on inspiration and sometimes on expiration. Typically, the jaw has rotated back and open, allowing air to be inspired both through the nose and the mouth. Snoring usually begins as a mild noise occurring occasionally. As the condition worsens, usually with age and weight gain, it becomes continuous, loud and obtrusive indicating a greater collapse of the throat. If the inspiratory effort interrupts the patient’s sleep, the condition is known as Upper Airway Resistance Syndrome (UARS). As the opening continues to decrease to the point of total blockage, causing a cessation of airflow, Obstructive Sleep Apnea (OSA) occurs. Patients with obstructive sleep apnea are at a significantly increased risk for:

- Hypertension

- Stroke

- Myocardial infarction

- Automobile accidents

- Impotence

- Weight gain

- Diabetes

- Atherosclerosis

Unfortunately, most patients and/or their bed partners complain only of the snoring because they are minimally aware of the other signs and symptoms of sleep disordered breathing.

 Treatments

Treatments for snoring and obstructive sleep apnea fall into one of three areas: surgical correction, Continuous Positive Airway Pressure known as CPAP, and oral appliance therapy. All three try to establish and maintain an open airway.

- Soft tissue surgery removes some of the soft tissue of the upper airway. This therapy, with a high morbidity, yields highly inconsistent success rates for both snoring and obstructive sleep apnea.

- Orthognathic surgery moves the maxilla and mandible forward to open the airway. This surgery must be done in conjunction with soft tissue surgery to be effective.

- CPAP effectively eliminates obstructive sleep apnea in a sleep lab. At home, however, only 2% of the patients will wear a mask attached to a machine for snoring or UARS. Only approximately 25% of the patients diagnosed with OSA wear CPAP consistently, and then only 50% of the time.

- Oral appliance therapy shows the greatest promise for effectively treating the broad range of sleep disordered breathing. Additionally, it is non-invasive, inexpensive, reversible, and is overwhelmingly preferred by patients. Several appliances have been clinically shown to be able to treat severe OSA.