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Sleep Apnea And The Orthodontist Juan M. Palomo. Episode 46. IOC 2020

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Farooq Ahmed

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

 

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