ISSN : 0376-4672
Obstructive sleep apnea (OSA), most common respiratory disorder of sleep, is characterized by intermittent partial or complete occlusions of the upper airway due to loss of upper airway dilating muscle activity during sleep superimposed on a narrow upper airway. Termination of these events usually requires arousal from sleep and results in sleep fragmentation and hypoxemia, which leads to poor quality of sleep, excessive daytime sleepiness, reduced quality of life and numerous other serious health consequences Untreated OSAS can cause various problems such as hypertension, diabetes, stroke, cardiac disease, daytime sleepiness. Various treatments are available, including non-surgical treatment such as medication or modification of life style, surgical treatment, continuous positive airway pressure (CPAP) and oral appliance (OA). Oral appliance is known to be effective in mild to moderate OSA, also genioglossus muscle advancement (GA) or maxillomandibluar advancement (MMA) is a good option for OSA patients with muscular or skeletal problems. Although the prevalence of OSA is increasing, the proportion of the patient treated by dentist is still very law. Dentists need to understand the mechanism of OSA and develop abilities to treat OSA patients with dental problems. The purpose of this paper is to give a brief overview about OSA and the dentist’s role in OSA patients
1. Kim J, In K, Kim J, You S, Kang K, Shim J, Lee S, Lee J, Lee S, Park C, Shin C. Prevalence of sleepdisordered breathing in middle-aged Korean men and women. Am J Respir Crit Care Med 2004; 170:1108-1113.
Malhotra, White DP. Obstructive sleep apnoea. Lancet 2002; 360:237-245
2. Engleman HM, Douglas NJ. Sleep. Sleepiness, cognitive function, and quality of life in obstructive sleep apnonea/hypopnoea syndrome. Thorax. 2004; 59:618-622.
3. Robinson GV, Stradling JR, Davies RJO. Sleep. Obstructive sleep apnea/hypopnea syndrome and hypertension. Thorax 2004; 59:1089-1094.
4. Marin JM, Carrizo SJ, Vicente E, Agusti AG, Longterm cardiovascular outcomes in men with obstructive sleep apnoeahypopnoea with or without treatment with continuous positive airway pressure:an observational study. Lancet 2005; 365:1046-1053.
5. Jean-Louis G, Zizi F, Clark LT, Brown CD, McFarlane SI., Obstructive sleep apnea and cardiovascular disease: Role of the metabolic syndrome and its components. J Clin Sleep Med 2008; 15:4(3):261-272.
6. Berry RB, Brooks R, Gamaldo CE, et al.; for the American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, Version 2.1. www.aasmnet. org, Darien, IL: American Academy of Sleep Medicine, 2014.
7. American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults:recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999; 22-667-689.
8. Hoffstein V, Szalai JP. Predictive value of clinical features in diagnosing obstructive sleep apnea. Sleep 1993; 16:118-122
9. Viner S, Szalai jP, Hoffstein V. Are history and physical examination a good screening test for sleep apnea? Ann Intern Med 1991; 115:356-359
10. American Academy of Sleep Medicine. Internationational classification of sleep disorders , 3rd edition.: Diagnostic and coding manual. Westchester, Illinois: American Academy of Sleep Medicine, 2014)
11. Rauscher H, Formanek D, Popp W, et al. Nasal CPAP and weight loss in hypertensive patients with obstructive sleep apnoea. Thorax 1993; 48:529-533
Schwartz AR, Gold AR, Schubert N, et al. Effect of Weight Loss on Upper Airway Collapsibility in Obstructive Sleep Apnea. Am Rev Resp Dis 1991; 144:494-498.
12. Smith P, AR Gold DM, EF Haponik, ER Bleecker. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985 ; 103:850-855.
13. Kajaste S, Brander PE, Telakivi T, et al. A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med 2004; 5:125-131
14. Kushida CA, Littner MR, Hirshkowitz M, et al. Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients with Sleep-Related Breathing Disorders. Sleep 2006; 29:375-380.
15. Kushida CA, Morgenthaler TI, Littner MR, et al. Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances:An Update for 2005. Sleep 2006: 29:240-243
16. Buchwald H, Avidor Y, Braundwald E, et al. Bariatric surgery: a systematic review and metaanalysis. JAMA 2004; 292:1724-1737
17. Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006; 29:1031-1035.
18. Pevernagie DA, Stanson AW, Sheedy PF 2nd, Daniels BK, Shepard JW Jr. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med 1995; 152:179-185.
19. Morgaenthaler TI, Sheldon K, Tofilo LC, et al. Practice Parameters for the Medical Therapy of Obstructive Sleep Apnea. Sleep 2006; 29(8):1031-1035.
20. Heart Health Study. Bibliography. http://www. jhucct.com/shhs/details/biblio.htm.
21. Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnea/hypopnea syndrome. Sleep Med Rev 2003; 7:81-99.
22. Pépin JL, Krieger J, Rodenstein D, et al. Effective compliance during the first 3 months of continuous positive airway pressure: a European prospective study of 121 patients. Am J Respir Crit Care Med 1999; 160:1124-1129.
23. Seung Hyun Yoon, Seong Taek Kim. Efficacy of Mandibular Advancement Device in Management of Obstructive Sleep Apnea. J Kor Sleep Soc 2006; 3:74-78
24. Ngiam J, Balasubramaniam R, Darendeliler MA, Cheng AT, Waters K, Sullivan CE. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Australian dental journal 2013; 58:408-419
25. Li KK, Guilleminault C, Riley RW, Powell NB. Obstructive sleep apnea and maxillomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2002; 60:526-530; discussion 31.
26. Li KK, Powell NB, Riley RW, Troell RJ, Guilleminault C. Long-Term Results of Maxillomandibular Advancement Surgery. Sleep & breathing = Schlaf & Atmung 2000; 4:137-140.
27. Riley R, Guilleminault C, Powell N, Derman S. Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report. Sleep 1984; 7:79-82.
28. Li KK, Powell NB, Riley RW, Troell R, Guilleminault C. Overview of phase I surgery for obstructive sleep apnea syndrome. Ear, nose, & throat journal 1999; 78:836-7, 41-45.
29. Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and longterm care of obstructive sleep apnea in adults. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2009; 5:263-276.
30. Kim J, In K, Kim J, et al. Prevalence of sleepdisordered breathing in middle-aged Korean men and women. American journal of respiratory and critical care medicine 2004; 170:1108-1113.
