ReviewDiagnosis and treatment for obstructive sleep apnea: Fundamental and clinical knowledge in obstructive sleep apnea
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)
- et al.
Home diagnosis of sleep apnea: a systematic review of the literature. An evidence review cosponsored by the American Academy of Sleep Medicine, the American College of Chest Physicians, and the American Thoracic Society
Chest
(2003) - et al.
Management of snoring and obstructive sleep apnea with mandibular repositioning appliances: a prosthodontic approach
Dent Clin North Am
(2014) - et al.
Obstructive sleep apnoea syndrome: comparison between polysomnography and portable sleep monitoring based on jaw recordings
Neurophysiol Clin
(2011) - et al.
Mandibular posture during sleep in healthy adults
Arch Oral Biol
(1998) - et al.
Mandibular posture during sleep in patients with obstructive sleep apnoea
Arch Oral Biol
(1999) - et al.
Mandibular posture during sleep in healthy adults
Arch Oral Biol
(1998) - et al.
Effect of an exclusion range of jaw movement data from the intercuspal position on the estimation of the kinematic axis point
Med Eng Phys
(2014) - et al.
Airway evaluation in obstructive sleep apnea
Sleep Med Rev
(2008) - et al.
A cephalometric and electromyographic study of upper airway structures in the upright and supine positions
Am J Orthod Dentofacial Orthop
(1994) - et al.
The effect of head posture on the pharyngeal airway space (PAS)
Int J Oral Maxillofac Surg
(2002)
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
Lateral cephalometric analysis of the pharyngeal airway space affected by head posture
Int J Oral Maxillofac Surg
Influence of oral appliances on craniocervical posture in obstructive sleep apnea–hypopnea syndrome patients
J Prosthodont Res
A systematic review of screening questionnaires for obstructive sleep apnea
Can J Anaesth
Comparing the Berlin and the ARES questionnaire to identify patients with obstructive sleep apnea in a dental setting
Sleep Breath
Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults
J Clin Sleep Med
Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians
Ann Intern Med
Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians
Ann Intern Med
Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea
Sleep
Practice parameters for the indications for polysomnography and related procedures: an update for 2005
Sleep
Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults
Sleep
Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005
Sleep
Oral appliances for snoring and obstructive sleep apnea: a review
Sleep
AADSM Treatment Protocol: Oral Appliance Therapy for Sleep Disordered Breathing: An Update for 2012
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
Practice parameters for the treatment of obstructive sleep apnea in adults: the efficacy of surgical modifications of the upper airway
Sleep
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