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hygiene - the international C.E. magazine of dental hygiene

I 19hygiene 1_2012 C.E. article_ sleep apnea I “It happens most frequently during REM sleep, and breathingstopsfor10to30seconds,whichresultsin reducedlevelsofoxygendissolvedintheblood.”4 The patientwiththeOSASdoesnotknowthisishappen- ing. A person’s quality and quantity of sleep is often inadequate. These interruptions of sleep can affect a person’s mental and physical state — and lead to additional problems in the oral cavity. _What is central sleep apnea? Central sleep apnea is caused by the brain failing to signal the breathing-control muscles to work. With central sleep apnea, snoring is infrequent to rare because there is no airway obstruction. Though this disorder is less common than obstructive sleep apnea,itisimportanttoaddressfortheoverallhealth of the sleeper. Oral appliances do not work in this situation. Central sleep apnea is diagnosed by sleep studies and typically treated with medications. _What is complex sleep apnea? Complex sleep apnea is a combination of ob- structive sleep apnea and central sleep apnea. Some patientswithobstructivesleepapneadevelopcentral sleep apnea while on treatment with continuous positive airway pressure (CPAP).”2 Thisarticlefocusesonobstructivesleepapneaand how it relates to the oral cavity. _Cause of obstructive sleep apnea syndrome Tongue muscles, soft palate and uvula relax and/ or sag (Fig. 2), causing snoring, difficulty breathing and breathing cessation. Obesity, alcohol consump- tionandsleepmedicationscanexacerbatethecondi- tion. Snoring and gasping for air causes the person to wake several times a night, preventing the person from getting the proper sleep needed to function. Sleep apnea is often present in people who are overweight, have physical abnormalities such as a deviated septum or have other abnormalities of the nose or throat. The sleeper tries to breathe, creating a tighter seal, which decreases oxygen flow to the brain. The sleeper awakens gasping for air. _Effects and oral effects Studies on sleep apnea are fairly new, and diag- nostic evidence is evolving. Snoring is one of the symptoms of obstructive sleep apnea syndrome; however, not all individuals who snore necessarily have OSAS. Friedlander says, “Even when the airway is partially open, obstruction occurs frequently and results in a loud irregular snoring sound caused by air rushing through the narrow passage and stimu- lating the soft palate, uvula, throat walls and tongue to vibrate.”5 If an OSAS patient is left untreated, the condition can worsen over time. Risk can increase for hypertension, stroke, myocardial infarction, an- oxic seizures and sudden death while asleep.3 Sleep apnea can be alleviated with oral devices and/or surgical procedures, however some complications have arisen in the oral cavity because of some of the devicesusedtocorrectorminimizeobstructivesleep apnea. _Signs and symptoms Dental professionals may be the first health-care providers to suspect possible OSAS in a patient5 because of signs and symptoms exhibited within the oral cavity. These include: “macroglossia (Fig. 3) and enlarged pharynx, narrowed posterior airway space resulting from a long soft palate by the uvula lying below the base of the tongue; the tongue lying above the mandibular plane of occlusion and small mandible.”5 Signs and symptoms of OSAS while sleeping can include drooling, xerostomia, restlessness, bruxism, choking or gasping, snoring, breathing pauses and diaphoresis.Butanindividual’ssymptomsassociated withOSASarenotlimitedtosleepingproblems.Dur- ingwakinghoursthepatientmayexperiencedepres- sion, difficulty concentrating, fatigue and insomnia. Other signs can include gastroesophageal reflux disease(GERD),irritabilityandsleepinessthroughout the day. Coughlin says, “If OSAS continues to be un- treatedoritisneverdiagnosed,thesleepingdisorder may elevate blood pressure and the potential for mortality increases.”6 Fig. 3_Macroglossia (enlarged tongue). Fig. 3