Review
Diagnosis and treatment for obstructive sleep apnea: Fundamental and clinical knowledge in obstructive sleep apnea

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Abstract

Purpose

This review article covers the diagnosis and treatment of obstructive sleep apnea (OSA) from a dental perspective. It addresses the issue of when and how to screen for and then, if indicated, refer the patient for a more comprehensive.

Study selection

Our focus in this article was on identifying current unanswered questions that relevant to OSA problems that dental scientists have to pursue and on providing valuable information on that problems, consequently the previous studies which investigated or reviewed the diagnosis and treatment of OSA were included. In addition, we included studies on jaw movements during sleep and on the use of a lateral cephalometric film related to the diagnosis and treatment of OSA.

Results

The role of portable sleep monitoring devices versus full laboratory polysomnography is discussed. This review also describes what is known about the efficacy of mandibular advancement devices and when and how they fit in to a treatment program for a patient with obstructive sleep apnea. Finally some basic research is presented on jaw movements during sleep and how a lateral cephalometric film can be used to assess the changes of the airway with body posture and head posture.

Conclusion

This article provides the valuable suggestions for the clinical questions in the diagnosis and treatment of OSA.

Introduction

There are multiple unanswered questions that are relevant to obstructive sleep apnea problems that dental scientists have to pursue. Once these questions are answered, dental and other health care clinicians need to figure out how and when to apply the suggested solutions on their patients. In this review, several of these questions are addressed. For example, the question: “Should dentists incorporate a sleep breathing disorder screening examination into their work-up of a new patient?” is discussed. Second, if the answer to the prior question is positive, then the next logical questions is: “What is the best method to screen dental patients and when is it appropriate to refer a patient for comprehensive diagnosis of their possible obstructive sleep apnea disorder?” This review lays out the suggested process for such a work-up.

Once a clinically important obstructive sleep apnea problem is confirmed, then the next logical questions is: “How is it best treated?” In this review there is a discussion of what has been recommended as a first and second line treatments and specifically, what is the role of a mandibular advancement device (MAD) are in this treatment algorithm. Of course there are many questions about co-morbid conditions where the answers are yet to be determined. For example, “What is the significance of the relationship between sleep bruxism and obstructive sleep apnea?” Another unanswered question is: “What is the relationship between gastroesophageal reflux disease (GERD) and obstructive sleep apnea?” A third important unanswered question is: “What is the impact of orofacial pain and/or temporomandibular disorders and headache on sleep apnea treatment and vice versa?” All three of these questions will require more investigations. This review discusses in detail the role of a mandibular advancement device as a treatment. Finally this review discusses new scientific findings on (1) airway imaging collected with a lateral cephalometric radiograph and (2) the motion of the jaw during sleep.

Section snippets

Clinical diagnosis and management for obstructive sleep apnea (OSA)

Because obstructive sleep apnea is a growing concern in health care and untreated, it can cause major health problems, this review suggests that dentists should indeed screen their new patients for this disorder. One of the most efficient screening methods for obstructive sleep apnea in a dental setting is a questionnaire and there are several validated questionnaires to choose from. Two of the best are the Stop-Bang Questionnaire and the Berlin Questionnaire [1], [2] (Fig. 1). Once a patient

Jaw movement during sleep

Several studies have examined apnea events and jaw positioning during sleep in an attempt to understand the effect of apnea on mouth opening and vice versa. In 1999, Miyamoto et al. measured the vertical mandibular position during sleep in patients with OSA and found that it was more open when compared with healthy adults without OSA, and that the mandibular opening increased progressively during apneic episodes and decreased at the termination of apneic episodes [23], [24]. This data suggests

Techniques of evaluating airway configuration on cephalometric images

In 2008, a review article was published that examined the issue of airway imaging for OSA [38]. Specifically, the authors of this systematic review examined how valuable the various imaging methods of the airway were in the decision making process for evaluating airways. The authors reviewed (1) endoscopy during wakefulness, (2) the value of the Mueller Maneuver, static radiologic imaging techniques (X-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)),

Conclusion

Based on this review several conclusions are suggested in response to the questions being asked. These questions and answers are listed below:

  • Q1: Should dentists incorporate a sleep breathing disorder screen examination into their work-up of a patient? Answer: Yes, dentists need to screen all patients for significant snoring and obstructive sleep apnea.

  • Q2: What is the best diagnostic strategy to screen dental patients for snoring and obstructive sleep apnea? Answer: In most cases a short sleep

Conflict of interest

No conflicts of interest.

References (52)

  • W. Zhang et al.

    Effects of head and body positions on 2- and 3-dimensional configuration of the oropharynx with jaw protruded: a magnetic resonance imaging study

    Oral Surg Oral Med Oral Pathol Oral Radiol Endod

    (2011)
  • E. Anegawa et al.

    Lateral cephalometric analysis of the pharyngeal airway space affected by head posture

    Int J Oral Maxillofac Surg

    (2008)
  • Y. Inoko et al.

    Influence of oral appliances on craniocervical posture in obstructive sleep apnea–hypopnea syndrome patients

    J Prosthodont Res

    (2009)
  • A. Abrishami et al.

    A systematic review of screening questionnaires for obstructive sleep apnea

    Can J Anaesth

    (2010)
  • R. Enciso et al.

    Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting

    Sleep Breath

    (2011)
  • L.J. Epstein et al.

    Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults

    J Clin Sleep Med

    (2009)
  • A. Qaseem et al.

    Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians

    Ann Intern Med

    (2013)
  • A. Qaseem et al.

    Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians

    Ann Intern Med

    (2014)
  • R. Ferber et al.

    Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea

    Sleep

    (1994)
  • C.A. Kushida et al.

    Practice parameters for the indications for polysomnography and related procedures: an update for 2005

    Sleep

    (2005)
  • A.L. Chesson et al.

    Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults

    Sleep

    (2003)
  • C.A. Kushida et al.

    Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005

    Sleep

    (2006)
  • K.A. Ferguson et al.

    Oral appliances for snoring and obstructive sleep apnea: a review

    Sleep

    (2006)
  • American Academy of Dental Sleep Medicine

    AADSM Treatment Protocol: Oral Appliance Therapy for Sleep Disordered Breathing: An Update for 2012

    (2012)
  • L. Gauthier et al.

    Position paper by Canadian dental sleep medicine professionals on the role of different health care professionals in managing obstructive sleep apnea and snoring with oral appliances

    Can Respir J

    (2012)
  • Report of the American Sleep Disorders Association

    Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway

    Sleep

    (1996)
  • Cited by (6)

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