Obstructive Sleep Apnea

What is Obstructive Sleep Apnea?

Obstructive Sleep Apnea (OSA) is a clinically recognised sleeping disorder, characterised by the repeated collapse of the upper airway during sleep and the obstruction (cessation) of breathing. This corresponds with a reduction in blood oxygenation. OSA should not be mistaken for snoring, which is the partial obstruction of the airway, and the vibration of the pharangyeal tissue resulting from forced inhalation/expiration. Snoring and sleep apnea are two separate conditions, however snoring can occur in the presence of OSA and be a warning sign of potential sleep apnea patients.

What are the signs symptoms of obstructive sleep apnea?

Symptoms of OSA include snoring, interrupted sleep, as well as fatigue and drowsiness during the day. Patients who also suffer from one or more of the following are more at risk of developing OSA or are likely to currently experience OSA:

  • ▪ Obesity
  • ▪ Small or retruded jaw
  • ▪ High blood pressure
  • ▪ Cardiovascular problems
  • ▪ Hypertension
  • ▪ Restless sleep
  • ▪ Insomnia
  • ▪ Irritability
  • ▪ Depression
  • ▪ Chronic fatigue
  • ▪ Intellectual deterioration
  • ▪ Memory lapses
  • ▪ Chocking during sleep
  • ▪ Headaches/migraines
  • ▪ Large tonsils/adenoids
  • ▪ Double chin (large neck)
How is obstructive sleep apnea diagnosed?

A diagnosis of OSA can be made on the basis of a comprehensive medical history, questionnaires (e.g. The Epworth Sleep Scale) and an overnight polysomnographic study. This study can be performed either at home or in a sleep clinic and can distinguish between simple snoring and OSA.

What are the causes of OSA?

The cause of OSA, is due to a number of anatomical and patho-physiological factors.¹ Anatomical factors: Underdevelopment of the maxilla and retrusion of the jaw reduce the size of the upper airway. This pushes the tongue backwards and obstructs the airway passage. By obstructing the airway passage there is an increased risk of developing OSA. Patho-physiological factors: Functional impairment of the upper airway muscles promotes the collapse of the upper airway. This functional impairment may come from numerous sources. These include obesity, metabolic syndrome, diabetes, alcohol, smoking, consumption of mucus producing foods and/or blood acidosis. These factors contribute to an accumulation of fatty tissue in the walls lining the airway and tire airway muscles leading to a collapse of the upper airway, thereby contributing to the development of OSA.

How Can Obstructive sleep Apnea be treated?

The treatment of OSA depends on how severe the disorder is, there are usually four main treatment options. The first of which involves lifestyle modifications such as weight loss, limiting evening alcohol consumption and smoking; however, this is usually only effective in mild cases. The upper airway surgery and the use of a CPAP are two effective options for the treatment of OSA however both are quite invasive and cumbersome. The best option is an oral appliance which can deliver good results within a short period of time. Mandibular (lower jaw) Advancement Devices (MADs) are the most common dental appliances used to treat OSA and are available in numerous designs. They work by advancing the mandible forward, pulling the tongue away from the oro-pharyngeal cavity and thereby increasing the size of the oro-pharyngeal cavity. The SOMA is a type of MAD used to treat sleep apnea and a multitude of other health problems. It is based on the same fundamental principles of mandible protrusion yet it is fundamentally different from preceding MAD models as it allows for the orthodontic correction of the upper jaw facilitating permanent changes in facial architecture. This is an important differentiation because through the usage of the SOMA, a patient can eventually reach a stage of permanent mandibular change and will no longer require the use of any oral appliance to overcome OSA. It works on the principle that the position of the mandible is dependent on the location of specific teeth within the maxillary arch. The SOMA has three adjustable cogs incorporated into its design and is intended to be worn with a certain level of tension to push against the teeth of the upper jaw. This helps to maintain sufficient pressure and move teeth into a more anatomically correct position. With the expansion of the maxillary arch, the mandible moves forward in a similar manner to that of conventional MADs, however this new orientation of the mandible is permanent. At Wholistic Dentistry we have had numerous reports of patients who have reported complete resolution of snoring and improvement in previously reported symptoms of OSA.