Sleep Apnea − Silver Spring MD
OSA occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep.
What is SLEEP-DISORDERED BREATHING (SDB)?
- SDB is breathing difficulties occurring during sleep ranging from frequent loud snoring to obstructive sleep apnea (OSA)
There are two main types of sleep disorders under SDB
- Obstructive sleep apnea (OSA)
- Central sleep apnea (CSA)
WHAT IS OBSTRUCTIVE SLEEP APNEA (OSA)?
- The Most common form of SDB is Obstructive Sleep Apnea. OSA occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep
- Apnea is a cessation of airflow for ≥10 seconds, a reduction of airflow greater than 90% of baseline
- Hypopnea: a decrease in airflow lasting ≥10 seconds with a 30% oxygen reduction in airflow and with at least a 4% oxygen desaturation from baseline
Obstructive Sleep Apnea can be Mild, Moderate, or Severe.
- AHI (Apnea–Hypopnea Index) is the numerical value assigned for how many times a person pauses their breathing per given time.
- AHI = 0-4 Normal range
- AHI = 5-14 Mild sleep apnea
- AHI = 15-30 Moderate sleep apnea
- AHI > 30 Severe sleep apnea
Signs and symptoms of Sleep Apnea
- LACK OF ENERGY
- MORNING HEADACHES
- FREQUENT NOCTURNAL URINATION
- LARGE NECK SIZE
- EXCESSIVE DAYTIME SLEEPINESS (EDS)
- NIGHTTIME GASPING, CHOKING OR COUGHING
- GASTROESOPHAGEAL REFLUX (GE REFLUX)
- IRREGULAR BREATHING DURING SLEEP (IE, SNORING)
WHAT IS CENTRAL SLEEP APNEA
- Central sleep apnea is the less common type of sleep apnea and occurs when the area of the brain that controls breathing does not send the correct signals to the breathing muscles. Can occur with OSA or alone.
- Approximately 42 million American adults have SDB, 1 in 5 adults has mild OSA
- 1 in 15 has moderate to severe OSA
- 9% of middle-aged women and 25% of middle-aged men suffer from OSA
- 75% of severe SDB cases remain undiagnosed
Increased Risk Factors For Sleep Apnea
- Male gender
- Obesity (BMI >30)
- Excessive use of alcohol or sedatives
- Upper airway or facial abnormalities
- Family history of OSA
- Neck circumference of (>17” men; >16” women)
- Endocrine and metabolic disorders
CARDIOVASCULAR CONNECTION TO OSA
- According to Americal Heart Association, 5.7 million people in the US have heart failure
- Approximately 76% of congestive heart failure patients have SDB
- 49% of atrial fibrillation patients and 30% of cardiovascular patients have SBD
- OSA presents in 70% of heart attack patients with AHI ≥5, and 52% of heart attack patients with AHI greater than or equal to 10
TYPE 2 DIABETES CONNECTION TO OSA
- OSA is associated with insulin resistance diabetes independent of obesity
- 48% of type 2 diabetes sufferers have sleep apnea. May have a casual role in the development of type 2 diabetes
- 86% of obese type 2 diabetic patients suffer from sleep apnea
STROKE CONNECTION TO OSA
- 65% of stroke patients have SDB
- Up to 70% of patients in rehabilitation therapy following stroke have significant SDB ,AHI >10
TRAFFIC ACCIDENTS CONNECTION TO OSA
- There is up to 15 fold increase of being involved in vehicular accidents in people with moderate to severe sleep apnea,and a fatality of 980 lives every year in the us.
Treatment of OSA with oral appliance & How Does It Work?
Oral appliances are indicated for the treatment of snoring and mild to moderate sleep apnea. Oral appliances also offer alternative for patients with severe OSA who cannot or will not tolerate positive airway pressure therapy or CPAP. Oral appliances for OSA must be prescribed by a physician and fitted by a dentist. The mechanical holding of the mandible forward in relation to the maxilla, and the prevention of the tongue from collapsing into the airway during sleep provides mechanisms that decrease the collapsibility and an increase in the dimensions of the upper airway. This simple and viable option in the treatment of sleep-related breathing disorders reduces the potential for obstruction.
Oral Appliances Types
The two main types of appliances for SBD are those that advance the mandible in relation to the maxilla, and those that hold the tongue in the protruded position. The custom made nocturnal mandibular advancement device is the most commonly used device, and is farther divided into adjustable and non adjustable. The adjustable device allows for adjustments for titration. Oral appliances are easy and comfortable to wear and most people adjust to the appliance with in couple of weeks.The small and convenient size makes it easy to carry it when traveling. Makes for a non-invasive reversible treatment.
The tongue retaining device is least popular because it lacks the ability to adjust for titration, can dislodge because of lack of suction and therefore has low compliance because of comfort issues. Mandibular advancement appliances are the most commonly used.
Elsabet H. Tekle, DDS
Exceptional and professional service!
- Jacque T
Fitting for new device was simple. Device itself worked miraculously. Snoring reduced 100% per sleep monitor SnoreLab (which is great and free trial and usage; costs only 2.99 to save multiple nights recordings).