Juan described OSA and the role orthodontists can play
Sleep
- Requirement of sleep: If no sleep 11 days = mortality
- Restorative process of the function from the day
- Function of sleep : remove neurotoxins Xie 2013
OSA
- Prevalence 4% Bradley 2002
- May contribute to neurodegeneration in older age Nathan 2018
- Diabetes, Stoke, Drepression, Insomnia, Hypertension (due to fragmented sleep and deoxygenation)
AHI index
- Measures number of events of upper airway collapse
- Event = 10 seconds of no breathing with reduction of oxygen in the blood.
- Severe 30 events per hour
- Moderate 15-30 events per hour
- Mild 5-15 events per hour
Patient factors
- Assess using validated questionnaire: www.stonbang.ca
OSA children
- 1-3% of children OSA
- Interruption of restorative process
- Hyperactivity, can be misdiagnosed as ADHD
- Tonsils may be aetilogy – Modified Mallampati
Imaging OSA
- 3D more accurate than 2D
- However static images, limited use of function
- Ceph: upper pharynx = 17mm +/- 4, lower pharynx 12mm but no transverse measurement
Treatment
- Oral exercises
- Wind instrument players = reduced risk of OSA Ward 2012
- Exercises increase oropharyngeal muscle strength – Vanessa et al
- Weight loss
- 10% reduction in weight = 20% reduction in AHI Yee 2006
- RME
- Systematic RV AHI decrease 70%, O2 saturation increase 9% Camacho 2017
- Mandibular advancement splint (MAS) Vs Tongue stabilising appliance (TSA) , favours MAS Sutherland 2011, Hamoda
