Dr Côté » Treatment of Sleep Apnea

Treatment of Sleep Apnea

For problems related to sleep apnea, the dentist makes an examination and delivers a diagnostic in line with the patient’s discomfort. Indeed, this is a condition for which a person stops breathing during sleep for 10 seconds or more, sometimes hundreds of times a night. This is one of the most common diseases among adults: up to 5% of women and 15% of men aged 30 to 60 years.

Traitement de l’apnée du sommeil
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What Should You Know?

More and more, doctors get asked which dental orthotics can solve snoring and sleep apnea problems.

  • Where do these orthotics come from? How do they work?
  • What are the indications?Are they efficient?
  • Will RAMQ reimburse the costs in case of apnea?Snoring
  • Case 1: The snoring patient
  • Case 2: The patient that failed with a nCPAP
  • Where to refer these patients?

A Brief History of Sleep Apnea Treatment

Charles Samelson, a Chicago psychiatrist, invented the first dental device against snoring and apnea in the late 1970s. Dr. Samelson was trying to fix his own snoring problem. His wife, a pianist, complained that the noise generated by snoring interfered with her “musical ear” and gave her fatigue during the day. Dr. Samelson produced beeswax molds of his tongue, which kept the airway open during sleep by pulling on the tongue by suction. Soon, beeswax was replaced by latex, and research was undertaken at Rush University Medical School. In 1982, the results were presented to the same scientific meeting where Dr. Colin Sullivan introduced the CPAP or nCPAP (Nasal Continuous Positive Airway Pressure), in his article published in the New England Journal of Medicine in 1981. The continuous positive airway pressure technique is the application of air pressure through a sealed mask on the nose by means of a compressor.

Bref historique du traitement de l'apnée du sommeil
Le principe de l’appareil

How Does It Work?

Since 1982, a multitude of devices have been introduced for the treatment of apnea. In fact, there are currently more than 80 different models on the market. While each model is different, the basic principle is the same: to exert traction on the tissues around the airways to clear them and allow air to pass more easily. While Dr. Samelson's device pulled on the tongue, most newer models attach to the lower jaw and pull it forward by pressing against the upper jaw.

Device Effectiveness

The success rate with wearing dental orthotics varies according to several criteria. If it’s a snoring patient, some studies have shown success rates up to 95%. Thus, in 95% of cases, snoring is eliminated completely or is reduced to an acceptable level. In the case of patients with obstructive sleep apnea, the success rate is lower. It would be between 50% and 80% depending on the study. This variance is due to criteria considered a success factor, or other selected or excluded criteria that differ from one study to another.
 
For example, European studies include thinner individuals compared to American studies that accept higher-weight candidates. And we know that the weight, not body mass index, influences directly the response to treatment with dental orthotics. Thus, the implication is that the thinner a candidate, the lower his apnea-hypopnea index, the smaller his neck circumference, and the more his lower jaw is retruded, the better his chances are of being successfully treated with dental orthotics. The patient’s sex is also an important prognostic factor, as women respond better than men to treatment with an oral splint. Also, a patient breathing well through the nose has better chances to tolerate orthotics. It is important to note that very good responses to treatment were obtained for some patients whose prognosis was medium or low. Furthermore, a study by Dr. Allan Lowe of the University of British Columbia compared the effectiveness of a nCPAP treatment with that of an oral splint. Taking into account adherence to treatment that is far greater with dental orthotics compared to nCPAP, Dr. Lowe has determined that effectiveness was comparable.
Indications, contre-indications et efficacité
Le coût de l’appareil

Device Cost

Despite constant effort by the medical community to find, diagnose and treat sleep apnea, epidemiological studies estimate that the vast majority of sleep apneics are not yet diagnosed. It can therefore be expected that physicians encounter even more apneic patients in their practice. With the new Canadian Thoracic Society guidelines, doctors will have to meet a growing number of apneic patients who will use dental orthotics in the treatment of sleep apnea and snoring. They will also see patients using a compressor wanting to switch to dental orthotics. It is therefore imperative that physicians have some knowledge of dental orthotics and their indications to direct patients adequately. Article from Medical News, Vol. 9 No. 22, November 4, 2009.

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Snoring

Snoring occurs when the vibration of respiratory tissues produces sound when a person is sleeping. Although snoring is firstly a social problem, studies tend to show that it is much more than an annoyance. In terms of sound, research indicates that a snorer can produce sounds up to 69 decibels. We know that a jackhammer produces sounds ranging from 70 to 90 decibels, so it’s not surprising that spouses of snorers sleep an average of one hour less per night than spouses of non-snorers. Interestingly, Sleep Journal published a study in 2008 that tells us that for serious snorers, the risk to suffer from hypertension increases by 40%, by 34% to have a heart attack, and by 67% to have a stroke, compared to people who do not snore. These results suggest clinicians should take snoring a lot more seriously.

Conclusion

Despite constant effort by the medical community to find, diagnose and treat sleep apnea, epidemiological studies estimate that the vast majority of sleep apneics are not yet diagnosed. It can therefore be expected that physicians encounter even more apneic patients in their practice. With the new Canadian Thoracic Society guidelines, doctors will have to meet a growing number of apneic patients who will use dental orthotics in the treatment of sleep apnea and snoring. They will also see patients using a compressor wanting to switch to dental orthotics. It is therefore imperative that physicians have some knowledge of dental orthotics and their indications to direct patients adequately. Article from Medical News, Vol. 9 No. 22, November 4, 2009.

Conclusion

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