what is… sleep disorders dentistry - squarespacedisorders+dentistry.pdf · yearly cost to society...

What is… Sleep Disorders Dentistry

John Viviano BSc DDS D ABDSM

Sleep Disorders Dentistry…

� … the treatment of “Sleep Disordered Breathing” � Eg. Snoring, UARS, Sleep Apnea, Nocturnal Bruxism

� Sleep Disordered Breathing is... � STILL often ignored by Primary Medical Care � Associated with Major Health Consequences

� Dentists are... �  ideally positioned to screen / refer / treat these disorders

Yearly Cost to Society (USA): Approaches $200 Billion


Some Perspective… •  Six of 10 adults say they have sleep problems •  Daytime sleepiness interferes with Daily Activities in four of 10 adults •  Annual direct/indirect cost of sleep-related problems approaching $200 Billion (USA) •  Over 100,000 motor vehicle accidents annually are sleep-related (USA) •  Disasters such as Chernobyl, Three Mile Island, Challenger, Bhopal, and Exxon

Valdez officially attributed to errors in judgment induced by sleepiness & fatigue. ��

Source: University of Maryland Medical Center http://umm.edu/programs/sleep/health/sleep-disorders#ixzz2fdCar5U3

� Think of “Sleep Disordered Breathing” as… � � Three Main Categories �  Snoring � Upper Airway Resistance Syndrome (UARS) � Obstructive Sleep Apnea (OSA)


Sleep Apnea found in… … 4% of men and 2% of Women (Age 40)

… Increases with each decade of life

… Higher in certain high risk groups …78% of Long Distance Truck Drivers …Highest on-the-job mortality of all professions

Snoring found in…

… 40% of men and 20% of women … Increases with each decade


�  With “Sleep Disordered Breathing”… �  The airway narrows or collapses �  Interfering with breathing during sleep �  Occurs at various levels of the airway �  Net Result…

� Snoring �  Soft Tissue Vibration

}  Soft Palate, Uvula, Tongue, Airway Walls etc

� Upper Airway Resistance Syndrome (UARS) �  Airway Narrows: extra effort required to breathe

causing arousals from sleep � Obstructive Sleep Apnea

�  Airway Narrows or Collapses may have Blood O2 Desaturation

.


� Why me… � Narrowing of the upper air-passages � Reduced airway muscle tone � Nasal obstruction � Obesity � Drugs � Alcohol �  Fatigue �  Smoking � Heredity


� Important Terminology

� Apnea: Breathing stops for 10 seconds or longer �  Hypopnea: 50% ⇓ in airflow and 4% ⇓ in blood O2

�  RERA: Respiratory Effort Related Arousal

�  Apnea Index (AI) �  Number of Apneas / hour of sleep

�  Apnea Hypopnea Index (AHI) �  Number of Apneas + Hypopneas / hour of sleep

�  Respiratory Disturbance Index (RDI) �  Number of Apnea + Hypopneas + RERAs / hour of sleep


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Spectrum of Disease & Recommended Therapy as per American Academy of Sleep Medicine Sleep 2006��*for patients that cannot be managed with Lifestyle Changes

Snoring

UARS (Sleepy Snorer)

Mild Sleep Apnea (5-15 Events/hour)

Moderate Sleep Apnea (15-30 Events/hour)

Severe Sleep Apnea (Over 30 Events/hour)


n  Typical Screening Questions… n  How Restful or Restless is your Sleep? n  How often do you Awaken during your Sleep

Period? n  Witnessed Apneas? n  Witnessed Snoring? n  Do you Awaken Tired? n  Daytime Fatigue? n  Do you have Morning Headaches

.


Epworth Sleepiness Scale Score over 10 suggests a Sleep Disorder


If you scored higher than 10… Ø You Should Ø See your Doctor… Ø You may need an overnight sleep

study…

n  Only a Physician can Diagnose these disorders… n  Sleep Study Provides Objective Measurement of…

�  Apnea �  Snoring �  Blood Oxygen �  Arousals from sleep �  Breathing Patterns �  …and much more

.


n Literature Validated Therapies AASM Sleep 2006 n Lifestyle Choices n Positional Therapy n Surgery n nCpap n Airway Orthotics

.


n  Lifestyle Choices… n  Reduce Weight n  Increase Physical Fitness n  Avoid Alcohol & CNS Depressant Medications n  Avoid Smoking

.


� Positional Therapy… �  For some, Apnea is worse when sleeping on back; gravity makes

it more likely for the tongue to fall back into airway and tissues to collapse and block the airway.

�  Sew Tennis Ball into the back of your PJ’s. �  So every time you try to sleep on your back, your reduced

comfort level will encourage you to role to your side

.


Sleep Apnea Treatments…

What do I do… Text your questions to 416 500 2901

� Surgery: most common are Palatal Surgeries or variations there of…


Most Common Surgery: UPPP or UP3

Success; 25-50% for OSA, 75% for Snoring

Example of Orthotic in

Mouth Example of Orthotic in

Hand

Mandibular Advancement Devices Airway Orthotic Worn in Mouth

Text your questions to 416 500 2901

Airway Orthotics… the Facts…

Ø Airway Orthotics considered First Line Therapy for Snoring, Mild, Moderate Sleep Apnea Sleep 2006:29:2

Ø 90% patient compliance after 2 ½ years Cranio 2000:18:2

Ø Ten of eleven prefer an Airway Orthotic over nCPAP for their long term treatment. Thorax 1997, 52:362-368

Know the Facts Before You Decide Which Therapy is For You

Text your questions to 416 500 2901

Laser Assisted Uvulopalatoplasty (LAUP)

◦ Success; Not for Apnea, 50% for Snoring ◦ Relapse a problem, Apnea may Worsen


nCPAP Pumps air into nose under pressure to

expand collapsed airway

� nCPAP: Pumps air into nose under pressure to expand collapsed airway

�  Overall, 65% compliance after 6 months

�  Average 3-4 nights a week, 3-4 hours a night

�  Compliance lower if <30 events per hour (Mild to Moderate Sleep Apnea)

�  Almost %100 Effective in Eliminating Apnea

�  BUT: when compliance is considered “Adjusted nCPAP effectiveness” is 50%

Eur Respir J 2000;16(5):921-7

. .


nCPAP Prescribed Most Often


The Airway

Orthotic Solution


Mandibular Advancement Devices Most Effective Airway Orthotics

Some Examples…


Dorsal

Herbst

EMA

Example of Orthotic in Mouth

SUAD

Narval

Example of Orthotic in Hand Tap

Silencer


Airway Blockage Without Orthotic

Airway Splinted Open With Orthotic

Airway Without Airway Orthotic Airway With Airway Orthotic

Airway Orthotic increases Airway Size Making the Airway Less Collapsible

See MRI Images Below Showing Increase in Airway Size

.

Increase Occurs with Mandibular Advancement


�  Airway Orthotic Side Effects: �  Mostly Short lived and Upfront

�  Mostly due to resisting the new jaw position during sleep �  Once jaw resistance stops – the discomforts stop

�  Excessive Salivation lasts for approximately 2 Weeks �  Long Term Wear is Associated with Bite Changes

�  This same side effect occurs with long term nCPAP wear

�  No permanent cases of TMJ have been reported


Airway Orthotics… the Facts…

�  Airway Orthotics are considered First Line Therapy for the management of Snoring, Mild & Moderate Sleep Apnea. Sleep 2006:29:2

�  256 patient study – 90% patient compliance after 2 ½ years of wear. CRANIO 2000:18:2

�  Ten out of eleven prefer an Airway Orthotic over nCPAP for their long term treatment. Thorax 1997, 52:362-368


Know the Facts Before You Decide Which Therapy is For You

The Dentist, Physician and Sleep Specialist work together in the treatment of Snoring and Sleep apnea.

Communication is Key to Optimum Treatment .


Thank You & Sweet Dreams

[email protected] SleepDisordersDentistry.com

what is… sleep disorders dentistry - squarespacedisorders+dentistry.pdf · yearly cost to society...

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