Each night when I go to sleep, I die, and the next morning, when I wake up, I am rebornMahatma Gandhi
A good laugh and a sound sleep are the best cures in a doctor's book. Sleep plays a prominent role in our lives, affecting both the physical and mental functioning of our bodies. Changes in the normal sleep pattern can have negative effects on our health and daily functioning.
Sleep disorders are serious and can be life-threatening. Awareness about these can help in the prevention of severe consequences. So we decided to interact with Dr. Mandava Prasad, Senior Professor and Head of the Department of Orthodontics & Dentofacial Orthopedics at Narayana Dental College & Hospital, Nellore, Andhra Pradesh, to get some information about one such potentially serious and common sleep disorder, i.e. Obstructive Sleep Apnea.
What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) is a sleep-related breathing disorder. The patient usually complains of frequent arousal from sleep at night due to partial or complete cessation of breathing. There is excessive day sleepiness and fatigue due to poor quality of sleep at night.
Why does OSA occur?
There is a significant relaxation of muscles in the back of the throat, leading to upper airway obstruction & partial or complete cessation of breathing in patients. This muscle relaxation is multifactorial, resulting from the interaction of several factors such as a large tongue and tonsils, obesity, sedatives, alcohol, muscle relaxants, and a retrognathic mandible (where the lower jaw is positioned much behind the upper jaw).
What are the symptoms of OSA?
Let's categorize the symptoms of OSA into general and dental. The hallmark symptom of OSA is frequent arousal from sleep at night due to obstruction of airflow. This obstruction of breathing usually lasts from 10 seconds to one minute. Other distinct features of OSA include loud snoring, morning headaches & drowsiness, mouth breathing, depression, and trouble concentrating.
There is also a potential risk of developing cardiac diseases, hormonal imbalances, and delayed neuronal growth (in the developing brains of children). The dental implications include dryness of mouth (xerostomia), clenching/grinding of teeth ( bruxism ), plaque buildup & periodontal diseases due to mouth breathing.
How is OSA diagnosed & treated?
About 80% of patients with obstructive sleep apnea remain undiagnosed. Orthodontists play a key role in the active diagnosis of OSA based on the general & oral examination and the patient's symptoms during dental visits.
A sleep specialist performs additional diagnostic tests such as polysomnography & oximetry and plans an effective treatment. Treatment of OSA ranges from behavioural interventions to surgical interventions.
Simple lifestyle changes such as quitting alcohol & smoking, weight loss, and positional therapy such as resting his/her head in a raised position are some of the behavioural interventions.
Apart from CPAP (Continuous positive airway pressure), removable or permanent oral appliance therapy (tongue retaining devices, mandibular advancement appliances ) is one of the non-surgical interventions prescribed by orthodontists that helps in the effective treatment of mild OSA.
Cases of severe OSA often require invasive treatment involving surgical correction of soft tissues like the tongue, soft palate & tonsils. In conclusion, the diagnosis & treatment of OSA is interdisciplinary, involving the active roles of pulmonologists, physicians, orthodontists, and ENTs.