Risk Factors for Obstructive Sleep Apnea that Orthodontists Might Want to Know
Obstructive Sleep Apnea (OSA) is an often-undiagnosed and potentially life-threatening condition that affects at least 5% of the population. If we knew that the next mild to moderate Class II teenager we evaluate in our practice is going to develop OSA before the age of 35, would we approach his/her treatment differently? Would we be less likely to offer a camouflage option, and more inclined to encourage absolute correction? The answer is likely to be “yes”. But how do we know? Body mass index (BMI) and mandibular retrusion are clearly associated, but not all people with a Class II malocclusion develop OSA, nor are everyone with OSA necessarily overweight. The etiology of OSA is multi-variable with familial predisposition playing a role. This presentation will look at the environmental, phenotypic and genetic risk factors involved in the development of OSA. Such insight might lead to an improved screening process for individuals at risk of developing OSA and may become part of our diagnostic and treatment planning protocols in orthodontics.
Learning Objectives:
- Relate important environmental and phenotypic risk factors for obstructive sleep apnea
- Evaluate genetic indicators that might predispose an individual to OSA
- Explore a different model for diagnosis and treatment planning of patients at risk for OSA.
Airflow Analysis After Maxillomandibular Advancement Surgery in Obstructive Sleep Apnea Patients
Maxillomandibular advancement surgery is now considered the most effective surgical treatment option for Obstructive Sleep Apnea. There are few studies showing the airway volume change after Maxillomandibular advancement surgery. Using computational fluid analysis, the pathophysiology of Obstructive Sleep Apnea can be better understood and the effectiveness of maxillomandibular advancement surgery can be evaluated.
Learning Objectives:
- Relate the pathophysiology and various surgical treatment options for obstructive sleep apnea
- Evaluate airflow characteristics following maxillomandibular advancement surgery.
Airway Implications of Orthodontic Therapy in Obstructive Sleep Apnea Patients
Recently, airway size has received a great deal of attention as it directly affects snoring, upper airway resistance syndrome and Obstructive Sleep Apnea. Orthodontists, with their knowledge and training of functional appliances and established skills to evaluate jaw position, are ideally suited to provide oral appliance therapy in this field. Sleep disordered breathing patients are excellent adherents to therapy after only a few nights sleep without interruption and the subsequent restoration of adequate REM sleep. Oral appliances have a direct effect on tongue posture during sleep and help to stabilize the mandible in a closed vertical position. Long term occlusal changes in adults are predominantly dental in nature, typically occur after more than two or three years of nightly wear and continue with time. A better response to appliance therapy is seen in those adult post titration subjects who exhibit a more anterior velopharyngeal wall, a larger radius of curvature of the airway and an increase in velopharyngeal size. A funded clinical trial has been underway for the last three years to develop clinical protocols for the use of oral appliance therapy for sleep disordered breathing in a child population. By evaluating orthodontic records (questionnaires, x-rays and dental study models) together with overnight sleep studies before and after treatment, new applications for oral appliance use and new protocols for therapy in children have been defined.
Learning Objectives:
- Describe the indications, contraindications, advantages and disadvantages of the currently-available appliances in the field
- Titrate an adjustable oral appliance to achieve the maximum effectiveness for the treatment of snoring and/or OSA
- Describe the results of clinical trials designed to compare the effectiveness of specific oral appliances and how they might compare to nasal continuous positive airway pressure or surgical procedures.