Sleep dentistry, also known as dental sleep medicine, is an area of dental practice focused on the management of sleep-related breathing disorders, including obstructive sleep apnoea (OSA). OSA is a common condition where the muscles in the throat relax excessively during sleep, causing a temporary blockage of the airway, which can lead to reduced oxygen levels in the blood and disrupted sleep. Individuals with sleep apnoea may experience snoring, daytime sleepiness, fatigue, and more serious health issues such as hypertension and heart disease if left untreated.
Dentists play a significant role in the treatment of sleep apnoea, often in collaboration with sleep specialists. The most prevalent treatment for OSA is continuous positive airway pressure (CPAP) therapy; however, not all patients are able to tolerate or adhere to this treatment. In such cases, dentists may offer oral appliance therapy, which involves a custom-fitted device that advances the position of the jaw and tongue during sleep to keep the airway open.
Early identification and management of sleep apnoea are crucial for preventing its complications. Dental professionals are uniquely positioned to screen for OSA due to their regular access to patients’ oropharyngeal anatomy and can recommend appropriate interventions or referrals. By effectively treating sleep apnoea, sleep dentistry not only improves sleep quality but also enhances overall health and quality of life for sufferers.
Understanding Sleep Apnoea
Sleep apnoea is an umbrella term for sleep-related breathing disorders, characterised by repeated episodes of partial or complete obstruction of the upper airway during sleep. The most common type is obstructive sleep apnoea (OSA), where the airway becomes blocked, leading to disrupted breathing and snoring.
The Pathogenesis of OSA involves a variety of anatomic and demographic factors. Anatomical deviations—like enlarged tonsils or a recessed chin—can narrow the airway, while demographic elements such as obesity and age increase the risk.
In patients with OSA, the natural muscle relaxation during sleep can result in the upper airway collapsing. This collapse causes episodes of interrupted breathing, known as apnoeas or hypopnoea, depending on their severity. These disruptions can lead to excessive daytime sleepiness, one of the hallmark symptoms of OSA.
Diagnosis generally includes overnight monitoring through polysomnography. This study measures different bodily functions during sleep, including the Apnoea-Hypopnoea Index (AHI) or the Respiratory Distress Index (RDI). AHI indicates the number of apnoeas and hypopnoea experienced per hour of sleep.
Autonomic functions can also be affected, with sleep apnoea potentially impacting cardiovascular health. For adult patients, assessing the risk factors—such as family history, lifestyle, and the presence of other conditions—is a crucial step towards a diagnosis and treatment plan.
Risk Factors:
- Overweight or obesity
- Increased age
- Male gender
- Positive family history
- Alcohol and sedative use
The correct management of OSA is vital as unaddressed, it can lead to a host of other health problems, underscoring its importance in both dental and general health spheres.
Diagnostic Techniques and Measures
Diagnosing sleep apnoea involves an array of techniques intended to assess sleep disturbances, ranging from oxygen levels to arousal frequency. These diagnostic measures provide healthcare professionals with critical data to determine the presence and severity of sleep apnoea.
Polysomnography and Home-Based Tests
Polysomnography (PSG) represents the gold standard in sleep apnoea diagnosis. During a PSG, patients spend the night in a sleep lab, where multiple physiological parameters are monitored, including:
- Brain activity: through electroencephalography (EEG)
- Eye movements: via electro-oculography (EOG)
- Muscle activity: using electromyography (EMG)
- Heart rhythm: ascertained by electrocardiography (ECG)
- Breathing patterns, airflow, and blood oxygen levels
Results reveal episodes of apnoea and hypopnoea, as well as the patient’s level of oxygen desaturation and arousal.
For those who cannot attend a sleep lab, home-based sleep tests provide an alternative. Home tests are more accessible and focus primarily on respiratory and oxygen saturation indicators. While they are less comprehensive, they remain a valuable tool in assessing obstructive sleep apnoea.
The Epworth Sleepiness Scale and Questionnaires
The Epworth Sleepiness Scale (ESS) is a subjective measure of a patient’s daytime sleepiness. It rates the likelihood of dozing off in various daily situations on a scale from 0 to 3, with the total score indicating the level of daytime sleepiness. A score higher than 10 suggests that a patient may have excessive daytime sleepiness, a common symptom of sleep apnoea.
Healthcare providers often supplement the ESS with sleep-related questionnaires to obtain a broader understanding of the patient’s symptoms. These can chart the frequency of sleep disturbances, the presence of loud snoring, episodes of breathing cessation observed by others, and the degree of morning fatigue. The subjective nature of these tools is balanced by the objective findings from polysomnography or home-based tests, ensuring a comprehensive diagnostic approach.
Treatment Approaches for Sleep Apnoea
Sleep apnoea is a condition that requires a multi-faceted approach for effective management. The selection of treatments often involves considerations of severity, patient preference, and physiological factors.
Lifestyle Changes and Behavioural Therapy
Patients diagnosed with sleep apnoea may see improvement through lifestyle modifications such as weight loss if they have a high body mass index (BMI), or by altering their sleep position to alleviate apnoea events—a practice known as positional therapy. Behavioural strategies also include avoiding alcohol and sedatives before sleep, which can exacerbate the condition.
Continuous Positive Airway Pressure (CPAP) and Alternatives
Continuous Positive Airway Pressure (CPAP) remains the gold standard for treating obstructive sleep apnoea (OSA). CPAP therapy involves wearing a nasal mask that delivers continuous air pressure to keep the airways open. For those who struggle with CPAP adherence, alternatives such as Bi-level PAP or Auto-titrating PAP devices may be considered, which adjust pressure levels to meet the needs of the patient during sleep.
Oral Appliance Therapy
Oral appliances, including mandibular advancement devices (MADs) and tongue-retaining devices, offer a less intrusive alternative to PAP therapy. These devices work by repositioning the jaw or tongue to maintain an open airway. Dental sleep medicine has recognised mandibular advancement splints as a key offering for patients with mild to moderate OSA or for those who are non-compliant with CPAP therapy.
Surgical Interventions
Surgical options are available for patients with anatomical factors contributing to sleep apnoea. Procedures like uvulopalatopharyngoplasty (UPPP) or tracheostomy may be considered in severe cases or when other therapies have failed. Systematic reviews and randomised controlled trials (RCTs) often influence the choice and refinement of surgical interventions, aiming at enhancing health-related quality of life in OSA. The role of a sleep specialist is crucial in determining the suitability of surgical treatment for each individual patient.
Dentistry’s Role in Managing Sleep Apnoea
Dentists play a crucial role in improving health-related quality of life for patients with obstructive sleep apnoea (OSA) by providing oral appliance therapy and patient education. They address snoring and OSA symptoms by fitting customised oral devices and advising on best practices for compliance and use.
Oral Appliances and Fittings
Dentists specifically trained in sleep dentistry can offer Oral Appliance Therapy (OAT) as a frontline treatment for mild to moderate OSA and for patients who cannot tolerate Continuous Positive Airway Pressure (CPAP) therapy. The two primary forms of oral appliances used in the management of OSA are:
- Mandibular Advancement Devices (MADs): These devices work by advancing the lower jaw slightly forward, opening up the airway.
- Tongue-Retaining Devices (TRDs): These devices hold the tongue in a forward position, preventing it from collapsing back into the airway.
For optimal results, these devices require proper fitting and regular adjustments. Dentistry professionals offer custom-made solutions, ensuring devices are not only effective in alleviating symptoms but also comfortable for the patient, aiding in better compliance.
Sleep Dentistry and Patient Education
Educating patients about the impact of OSA on quality of life and the importance of treatment compliance is an integral part of a dentist’s role in managing sleep apnoea. Effective patient education can cover:
- Understanding OSA: The implications of untreated OSA on general health and the benefits of treatment.
- Proper Use: Instructions on the correct usage and maintenance of oral appliances to maximise benefits.
- Lifestyle Recommendations: Advice on weight management, sleeping positions, and other behavioural adjustments to support the treatment of OSA.
- Regular Dental Check-ups: Encouragement of continual engagement with dentistry services for device monitoring and oral health maintenance.
Through these interventions, dentists reinforce the significance of sustaining treatment, thereby improving the overall health-related quality of life for those with OSA.