Obstructive Sleep Apnea (OSA) stands as a prevalent condition, representing over 80% of diagnosed sleep-related breathing disorders in the United States. It involves recurrent narrowing or collapse of the upper airway during sleep, leading to interruptions in breathing or reduced airflow. When asleep, decreased muscle activity in the throat can cause airway narrowing, particularly for individuals with certain risk factors such as obesity or anatomical variations.

What is Obstructive Sleep Apnea?

Obstructive apnea occurs when breathing stops or significantly decreases despite the effort, lasting at least 10 seconds during sleep, often ending with a brief awakening to restore breathing. Although some individuals may not show apparent symptoms, excessive daytime sleepiness, and loud snoring, especially when followed by breathing pauses, are typical signs. Snoring alone doesn't always indicate OSA, but when it's persistent and disruptive, it could be suggestive, particularly in children.

Symptoms and Risk Factors

Common symptoms associated with OSA may include nocturnal choking or gasping, loud or irregular snoring, observed apneas during sleep (reported by a spouse or bed partner), excessive daytime sleepiness, nocturia, dry mouth upon awakening, and morning headaches.

However, there can be variability among individuals with OSA, and some may not exhibit any complaints or identifiable symptoms.

Factors that increase the risk of obstructive sleep apnea include:

• Being overweight or obese
• Retrognathia or micrognathia (abnormalities in the lower jaw)
• Having a large tongue
• High arched palate
• Enlarged neck circumference
• Advancing age
• Enlarged tonsils or adenoids
• Nasal obstruction due to chronic nasal inflammation or allergic rhinitis
• Alcohol consumption

When left untreated, obstructive sleep apnea (OSA) leads to repetitive cycles of breathing interruptions and "micro-arousals" during sleep, causing oxidative stress and intermittent decreases in blood oxygen levels. Moreover, OSA can profoundly affect overall health, cognitive function, interpersonal relationships, and daily activities.

Sleep Study for Diagnosing OSA

The gold standard for diagnosing obstructive sleep apnea is an overnight attended sleep study, known as a polysomnogram. This study involves multiple recordings, including breathing patterns, airflow, sleep stage duration, respiratory events (apneas and hypopneas), brain-wave activity, oximetry, muscle activity, and cardiovascular function.

During a sleep study, obstructed breathing events are quantified using the apnea-hypopnea index (AHI), which represents the average number of apneas and hypopneas recorded per hour of sleep. The AHI is commonly used to categorize the severity of OSA, with scores of 5, 15, and 30 events per hour serving as standard cutoffs for mild, moderate, and severe OSA, respectively.

Treatment Options

CPAP Therapy: Continuous Positive airway pressure (CPAP) therapy stands as a primary treatment for managing adult obstructive sleep apnea. PAP devices utilize air pressure generated by a mechanical device to counteract airway narrowing during sleep. This involves delivering compressed air to the oropharynx through an airtight attachment, typically a mask covering the nose, which helps maintain the airway by splinting it open with increased air pressure. These devices come in various sizes and mask types. Consistent and proper use of PAP therapy can lead to improved sleep patterns and quality of life for patients.

Oral Appliances: Individuals with obstructive sleep apnea (OSA) have the option to explore oral appliances as a therapeutic approach in consultation with their dentist. Oral appliances are considered a simpler alternative for managing OSA, particularly for those with mild to moderate cases or severe OSA patients who struggle with continuous positive airway pressure (CPAP) therapy.

These appliances, custom-fitted by our dentists at South Shore Dental Care, are worn during sleep to stabilize the mandible and prevent the collapse of oropharyngeal tissues and the base of the tongue, thus keeping the upper airway open. There are various types of oral appliances available, all of which generally work by moving the mandible, tongue, and soft palate forward to increase the airway space and reduce the risk of collapse.

Oral appliances function by repositioning and stabilizing the mandible, tongue, hyoid bone, and soft palate in a forward position. Studies suggest that custom-fabricated mandibular advancement devices tend to yield better treatment outcomes compared to thermoplastic devices, primarily due to improved patient preference and compliance. Patients using oral appliances should use them nightly to control OSA symptoms effectively.

Oral Appliances at South Shore Dental Care in Holbrook, MA

There are different types of oral appliances available, each with its own unique features to suit different needs and preferences:

• Mandibular Advancement Devices (MADs): These are the most common oral appliances prescribed for sleep apnea. MADs gently shift your lower jaw forward while you sleep, which helps keep your airway open and allows for easier breathing. They're comfortable to wear and highly effective for preventing airway collapse.
• Tongue-Retaining Devices: If you have mild to moderate sleep apnea and find it hard to tolerate MADs, tongue-retaining devices might be a good option for you. These devices work by holding your tongue forward during sleep, preventing it from blocking your airway. They're simple to use and can make a big difference in improving your breathing at night.
• Combination Therapy Devices: For individuals with more complex sleep apnea or those who haven't responded well to other treatments, combination therapy devices may be recommended. These devices combine features of both MADs and tongue-retaining devices to provide comprehensive treatment.

If you suspect you or a loved one may have sleep apnea, seeking professional help is crucial. At South Shore Dental Care in Holbrook, MA, we specialize in diagnosing and treating various dental conditions, including those associated with sleep apnea. Whether you require an oral appliance, CPAP therapy, or a combination of treatments, we're here to help you breathe easier and sleep better.