What is sleep apnea?
Sleep apnea is a condition in which breathing stops periodically during sleep, as many as 20-30 times per hour. Each time there is an interruption in breathing during sleep, the resulting lack of oxygen alerts the brain, which wakes up to restart proper breathing. Since the time spent awake is so brief, most people with sleep apnea don't remember it, and many feel like they are getting a good night's sleep when, in fact, they are not. The constant wake-sleep, wake-sleep cycle prevents those with sleep apnea from achieving deep sleep, resulting in a constant drowsy feeling during the day.
What are the signs of sleep apnea?
The following symptoms can indicate the presence of sleep apnea. If you notice one or more of these, you should consult your physician to be evaluated for Sleep Apnea:
- Insomnia or difficulty sleeping
- Loud snoring at night
- Waking up at night short of breath
- Snorting or choking sounds during the night (indicating a restart of breathing)
- Headaches upon waking in the morning
- Falling asleep unintentionally during the day
- Extreme drowsiness throughout the day
Are there different types of sleep apnea?
There are three categories of sleep apnea. The most common is called obstructive sleep apnea (OSA), and occurs due to a physical blockage, usually the collapsing of the soft tissue in the back of the throat. Less common is central sleep apnea (CSA), in which breathing stops because the muscles involved don't receive the proper signal from the brain. And some people suffer from "mixed" or "complex" sleep apnea, which is a combination of obstructive and central.
What are risk factors for sleep apnea?
Obstructive sleep apnea is more common in males than females, and more common in older adults (40+) than younger adults and children. However, anyone — regardless of gender or age — can suffer from sleep apnea. Other risk factors include obesity, smoking, drinking, use of sedatives or tranquilizers, and family history. Central sleep apnea strikes most often in people with heart disorders, neuromuscular disorders, strokes, or brain tumors.
Is sleep apnea dangerous?
Sleep apnea is considered a serious medical problem and if left untreated it can lead to high blood pressure, increasing the risk of heart failure and stroke. The ongoing state of fatigue caused by sleep apnea can lead to problems at work or school, as well as danger when driving or operating heavy machinery. Sleep apnea can also cause complications with medication or surgery; sedation by anesthesia can be risky, as can lying flat in bed after an operation. If you know or suspect you suffer from sleep apnea, let your family doctor know before taking prescribed medication or having surgery.
How is sleep apnea treated?
Treatments for sleep apnea depend on the severity of each individual case, and the type of apnea. Basic treatment can be behavioral — for instance, patients are instructed to lose weight, stop smoking, or sleep on their sides instead of on their backs. Beyond that, oral devices can be used to position the mouth in such a way that prevents throat blockage. In more severe cases, surgery may be the best option.
Obstructive Sleep Apnea In Children
The American Academy of pediatric Dentistry (AAPD) recognizes that obstructive sleep apnea (OSA) occurs in 1-5 percent of the pediatric population,it can occur at any age but is most common in children ages 2-7.Undiagnosed and/or untreated OSA is associated with cardiovascular complications,impaired growth,learning and behavioral problems.Children should be screened by their physician and dentist for OSA and proper tests or referrals performed when necessary. Signs of untreated sleep apnea in school-aged children may include bed wetting and poor school performance due to misdiagnosed ADHD,aggressive behavior or developmental delay. Rare sequelae of untreated OSA include brain damage,seizures,coma and cardiac complications. These children also may experience impaired growth.
Etiology of OSA
Patients with certain anatomic and craniofacial anomalies,neuromuscular diseases or Down syndrome are at increased risk for development of obstructive sleep Apnea.Anatomic anomalies may include hypertrophic tonsils and adenoids,choanal atresia,respiratory tissue thickening (caused by diseases such as polysaccharidosis,achondroplasia),or obesity.Neuromuscular disorders with a component of hypotonia (e.g.,cerebral palsy,myotonic dystrophies,other myopathies) predispose children to OSA. Additionally,infants with gastroesophageal reflux disease may be at risk for OSAdue to upper airwayedema or laryngospasm.Exposure to environmental tobacco smoke also has been associated with OSA.
Midface deficiency,with or without micrognathia and certain surgical procedures (e.g.,pharyngeal flaps to correct velopharyngeal insufficiency) in these patients also may contribute to OSA.
Diagnosis of OSA
Pediatric dentists are in a unique position to be able to identify patients at greater risk.adenotonsillar hypertrophy and obesity are major risk factors for OSA in otherwise healthy children.The following questions can help identify patients at risk:
- Does your child snore loudly when sleeping?
-Does your child have trouble breathing while sleeping?
- Does your child stop breathing while sleep?
- Does your child occasionally wet the bed at night?
-Is your child hard to wake up in the morning?
-Does your child complain of headaches in the morning?
-Does your child tend to breathe through his/her mouth during the day?
-Have you or the teacher noticed your child being sleepy during the day?
If your child is suspected of being at risk for OSA,referral to the appropriate medical doctors (e.g., Otolaryngologist,pulmonologist,sleep medicine physician) is required.Then a clinical exam in addition to sleep study can confirm or rule out the diagnosis.
Treatment of OSA
There are surgical or non-surgical options for treatment,the latter include management of nasal allergies,continuous positive airway pressure(CPAP),weight reduction and changes in sleep hygiene.Previously, three types of oral appliances were commonly used for treatment of sleep-related breathing: mandibualr advancing devices,tongue retaining devices and palatal lift appliances. Some studies have advocated the use of non-surgical interventions such as rapid maxillary/palatal expansion or other intraoral appliances.As functional appliances alter the position and/or growth of the maxilla or mandible, a complete orthodontic assessment should be completed.
The most common surgical option for treatment of OSA is adenotonsillectomy with a range of other surgical procedures available for these patients.