Dental Sleep Medicine and NICE guidelines Professor Ama Johal
Introduction
Obstructive sleep apnoea –
- Sleep related breathing disorder
- Poorly understood
- 70% collapse retroglossal area
- Stops breathing
- Body movement occurs – body tries to wake patient up as suffocating
- = disturbed sleep
Health consequences
- Day time sleepiness
- Hypertension, heart disease, stroke – all stroke patients screened for OSA
Treatment
- Severe / mod- gold standard Continuous positive airway pressure CPAP
- Filters air and pushes at high force
- To be effective 4-6 hours, 7 days a week – NOT curative
- Compliance / adherence 30%
NICE guidelines 2021
- Symptomatic receive CPAP
- if not comply then if a person Mandibular Advancement Splint
- Require good dental and periodontal health
- Age 18 +
MAS appliance
- Anatomical – increase size of pharyngeal airway
- Mandible move forwards, tongue advances with it
- Post lingual – Best impact of patients who have tongue contribution to collapse 70% of patients
- Reduces airway collapsibility
- Physiological role – stimulate dilation of upper airway muscle – improving muscle strength and control
- Mandible move forwards, tongue advances with it
MAS appliance
semi customised Vs customised
Johal 2018 S/R
- Overall effects better with customised Vs semi customised
- AHI 3
- Daytime sleepiness 1
- Self reported wear: 7 Vs 3 nights per week
- Pt preference 95% prefer customised to semi-customised
Ideal design features customised Johal 2018
- Good retention – customised
- Semi adjustable – incremental advancement
- Allowing for further advancement and slow increase in airway
- Full occlusal coverage
- Minimal vertical opening
In high angle cases clockwise rotation of mandible – compresses post-palatal area and worsens airway IF increase vertical opening. Minimal occlusal opening prevents clockwise rotation
Follow up long term
- Unwanted occlusal change
- Mesial molar movement
- Reduction of OJ and OB approx. 1mm
- Proclination of 1mm lower incisors
Thank you to the sponsors who have allowed the podcast to continue, Triple O, Orthocare and the Aligner Intensive Fellowship.
Subscribe to get summary podcasts and blogs in orthodontics