What Is a Sleep Apnea Problem?
Actually, sleep apnea is one of several related conditions which include snoring, obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS). These conditions have all been successfully treated with mandibular advancement procedures (either dental devices or jaw/chin advancement surgery). OSA, UARS and snoring, to a lesser degree, are essentially due to collapse of the airway (total or partial) during sleep, and each can be severe enough to induce frequent sleep state changes.
These sleep state changes can deprive the individual of adequate deep sleep and induce daytime sleepiness (hypersomnolence). Of course, the most common affliction associated with snoring is the disturbance in the bed partner's sleep, although snorers clearly have a greater likelihood of having OSA. UARS is an intermittent partial collapse of the airway that produces labored breathing. The more serious of the three conditions is OSA since it produces an intermittent complete airway collapse during sleep.
Why Should I Be Concerned?
OSA is associated with increased mortality. The research indicates the risk is for individuals with moderate to severe OSA and another pulmonary or cardiac disorder (e.g. asthma, emphysema, and angina). In a routine patient, however, the main reason treatment is sought is because OSA has a major impact on their life style due to the daytime hypersomnolence it causes.
What Dental Procedures Can Be Used to Treat Sleep Apnea and Snoring?
Nasal CPAP is the principal non-dental treatment for these disorders. For the moderate to severe apnea sufferer, this treatment is very effective but often is not used by patients because it is inconvenient to attach the mask each night and sleep with it in place (Kribbs, 1993). Surgical solutions which involve the throat only have a significant failure rate (Scher 1996). In recent years, for the mild to moderate OSA patient, several good studies have shown the dental devices which advance the mandible as a very successful device to treat SDB. These devices are usually two full arch acrylic devices which cover all of the mandibular and maxillary teeth and are then attached together in such a way as to hold the jaw in a forward position. Although the degree of advancement varies between designs, it has been proposed that at least a 50% or greater movement is necessary to achieve success of the device. In 1989, Clark proposed that at least a 75% advancement is necessary. The advantage of the mandibular positioner is that it maintains a continuous, forward tongue position throughout the night and is designed so oral breathing is still possible if the nasal passage is blocked.
Why Does a Mandibular Advancement Work?
There are two basic theories which can be advanced to explain how a mandibular advancement works. The first and most prevalent theory is that the mandibular advancement works by increasing the airway caliber, thus making the airway's resistance to collapse with negative pressure produced by inspiration. The second theory is that there is a stretch-induced activation of the pharyngeal motor system where the device and this motor activation provides enough stiffness to the system to prevent collapse of the airway. At this time it is impossible to know which theory is more correct. An issue which researchers must consider is that the passive shape of the airway may not be the critical factor in prediction of OSA development at all. Instead the issue may be how collapsible the airway is when placed under negative pressure (inspiration). Assessing the later will require a completely different methodology than radiographic or MRI based images.
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