Sleep Apnea

Sleep related breathing disorders (SRBDs) are a diagnostic category of disease that encompasses obstructive phenomena including primary snoring, upper airway resistance syndrome, and obstructive sleep apnea (OSA), as well as central sleep apnea and sleep related hypoventilation. This page will mostly be referring to OSA and its relation to orthodontics.

Risk Factors for OSA

• Various craniofacial morphologies:
  • Retrognathia (lower jaw set further back)
  • Mandibular hypoplasia (small lower jaw)
  • Dolichocephalic facial type (long and narrow faces)
  • Narrow and deep palate
  • Steep mandibular plane angle (steep lower jaw angle)
  • Anterior open bite
  • Midface deficiency (flat midface, small maxilla)
  • Lower hyoid position
• Obesity (BMI >30)
• Menopause
• Gender (Male)
• Increasing age
• Genetics
• Smoking
• Alcohol or sedatives
• Nasal congestion
• Certain medical conditions like congestive heart failure, high blood pressure, or type 2 diabetes

Signs and Symptoms of OSA

• History of snoring, gasping respiration or choking, and witnessed pauses in breathing (apneas) during sleep
• Frequent nighttime awakenings
• Non-restorative sleep
• Morning headaches
• Excessive daytime sleepiness
• Difficulty with attention and concentration
• Mood disturbance
• Difficulty controlling other medical comorbidities such as diabetes mellitus, hypertension, and obesity

Diagnosis of OSA

Diagnosis of sleep apnea is performed by a sleep medicine specialist using an in-center overnight sleep study (polysomnography). Results are then interpreted by the specialist, and diagnosis and severity are established. Out-of-center sleep testing can also be used for appropriately selected patients.

Consequences of OSA

It is important to seek medical attention if sleep apnea is suspected. You can stop breathing numerous times a night, which can lead to several systemic health problems over time. 

Because OSA causes carbon dioxide levels to increase and oxygen levels to decrease, the heart has to pump harder and faster to compensate for the lack of oxygen. OSA has been linked to a series of serious health-related conditions, and should be investigated at the earliest opportunity.

Untreated OSA can lead to:

• Insulin resistance, coronary artery disease, congestive heart failure, heart attack, high blood pressure, stroke, cardiac arrhythmia, and sudden cardiac death.
• Excessive daytime sleepiness that increases the risk of car accidents.
• Decreased quality of life.
• Neurocognitive impairment that leads to decreased school and job performance.

Orthodontics and OSA

OSA is diagnosed by a physician. Your dentist or orthodontist may screen for OSA, and can help in the identification of underlying dentofacial concerns, and can assist the physician in managing your disease. 

Your orthodontist:

• Can perform an OSA screening assessment and refer at-risk patients for diagnostic evaluation.
• Once a diagnosis of OSA is made by the physician, a comprehensive treatment plan will be based on careful consideration of your individual needs and treatment goals. If your treatment involves orthodontics, a plan for treatment, monitoring, and long-term follow-up care will be developed by all practitioners involved in your care.
• Will work with your physician/s to determine which orthodontic or dental appliance will best treat your primary problem. This may involve maxillary expansion, braces or invisalign, and/or orthognathic surgery.

Your orthodontist is not able to manage your care alone. We will work closely with your team of physicians to optimize your care and treatment.

If you have any questions, please feel free to contact our office!