WHAT IS SLEEP APNEA?
Sleep Apnea Syndrome / Obstructive Sleep Apnea-Hypopnea (OSAH), together with insomnia, is one of the most frequent nighttime disorders, affecting between 4-6% of the population.
OSAH is the repetitive occurrence of breathing pauses during sleep, which is characterised by the appearance of shortness of breath associated with snoring and the presence of brief breathing stoppages (apneas).
Snoring and apnea is often associated with arousals that are not usually noticed by the patient, but end up causing a restless sleep and is related to the onset of fatigue and daytime drowsiness.
Likewise, the lack of proper ventilation in the upper airway system, is usually associated with low oxygen levels in blood, that will end up aggravating or causing arterial hypertension, ischemic heart disease, cardiac arrhythmias or strokes.
The picture on the left shows correct air flow through the oropharynx. The picture on the right shows an obstruction of the oropharynx (the tongue and soft palate have collapsed) resulting in a decrease of air flow and the occurrence of snoring or apneas.
Although OSAH is caused by an obstruction in the upper airway system, there are many other factors that increase its predisposition:
- Obesity and being overweight are the main risk factors given that the accumulation of fat around the pharynx makes it more collapsible.
- Old age and males.
- Tobacco, alcohol and sedatives for their depressive action on the respiratory system.
- Postural factors, such as sleeping face up.
- Physical alterations such as a short neck or small jaw.
- Changes in the oropharynx, as presented by a large tongue (macroglossia), a soft descended palate, or having large and swollen tonsils.
- Metabolic alterations as presented by hypothyroidism, acromegaly, and metabolic syndrome.
Usually the symptoms of obstructive sleep apnea appear gradually and worsen with age. The presence of fragmented sleep and low blood oxygen levels that occur during the distinct breathing stoppages (apnea) cause the following symptoms:
- Excessive sleepiness or daytime drowsiness.
- Loud snoring that interrupts sleep, accompanied by shortness of breath and suffocation, caused by the lack of air during sleep.
- Disrupted sleep. Nocturnal awakenings accompanied by body movements.
- Lack of concentration and memory loss.
- Morning headaches and irritability.
- Chronic fatigue.
The
diagnosis of this disorder is based on a structure of sleep study. This study includes a comprehensive interview and clinical examination, and is complemented by a cephalometric study and a nocturnal respiratory polygraphy (Apnealink system), that studies the respiratory and cardiac parameters, giving an analysis of apneic episodes, snoring and the changes in oxygen saturation. Sometimes it will be necessary to be referred to other medical professionals who will apply more sophisticated tests to complement our diagnosis, such as an overnight polysomnography performed by a neurophysiologist, a CT scan of the skull, dynamic studies of the respiratory system performed by a pulmnologist or an endoscopic examination of the airways performed by a otorhinolaryngologist.
Sleep study through a nocturnal polygraphy in the patient’s home (ApneaLink) in which successive apneas are seen (in red) and hypopneas (in blue), as well as lowered blood oxygen (desaturation) and snoring.
The
treatment of OSAH is multidisciplinary and varies according to each patient’s specific conditions, ranging from more conservative measures to surgery. In Clinica Kranion, conservative treatments are performed through postural therapy, sleep hygiene techniques, and intraoral placement of braces, also known as a mandibular advancement device (MAD).
The MAD improves airflow through the forwarded jaw, thus preventing the tongue from obstructing the airway.
The choice of an intraoral prosthesis is favoured by patients as the first option for treatment of OSAH due to its safety, easy handling and the fact that it is reversible.
If you would like more general information on sleep disorders, please visit the following websites:
Dra. Victoria Lòpez Iñesta.
- Degree in Dentistry.
- Masters in medicine and sleep physiology
- Member of the Spanish Society of Sleep
www.sesueno.org
- Member of the Oral Society of Sleep www.semods.es
Dr. José Manuel Torres Hortelano
- Degree in Dentistry from Complutense University, Madrid.
- Doctorate from the University of Valencia (www.educacion.es/teseo )
- Postgraduate in TMJ Pathology from the Gregorio Maranon General Hospital, Madrid.
- Certificate of training in Orofacial Pain. University of Medicine and Dentistry of New Jersey (USA).
- Diplomate, American Board of Orofacial Pain – ABOP (www.abop.net ).
- Lecturer for Continuing Education Courses SEDCYDO, 2003.
- President of the XIV Annual Meeting of the Spanish Society of Craniomandibular Dysfunction and Orofacial Pain (SEDCYDO), Alicante-2003 (www.sedcydo.com ).
- Expert in Ozone therapy, Ozone therapy course in the Ozone Research Centre, Cuba.
- Member of the spanish association of nedical professionals in ozone (www.aepromo.org ).
- Member of the Spanish Society of Pain (SED)
(www.sedolor.es )
- Member (full membership) of the European Academy of Craniomandibular Disorders (CDAD) (www.eacmd.org ).
- Co-director of Advanced Training Course in Occlusion, Craniomandibular Dysfunction and Orofacial Pain (www.cursosatm.com ).
- Exclusive and ongoing work in Craniomandibular Dysfunction and Orofacial Pain. Clinica Kranion, Alicante.