Obstructive sleep apnoea (OSA)
In deep sleep, the muscles of the throat relax. This does not normally cause any problems with breathing. However, in OSA the muscles at the back of the throat become so relaxed during sleep that part of the airway is closed off. Breathing effort increases to maintain airflow through a constricted airway. The increased work of breathing causes you to wake from sleep and resumption of normal airflow, with subsequent return to sleep and recurrence of sleep‐related upper airway collapsibility. This disruption in breathing may occur multiple times per hour for the entire duration of the patient’s sleep.
The risk of OSA is higher if:
- A person is overweight
- During hormonal fluctuations such as pregnancy or menopause
- A condition that leads to excess tissue in the airway is present eg: enlarged tonsils or jaw deformities.
- Nasal obstruction is present.
Signs and symptoms
- A history of snoring, gasping respiration or choking, and witnessed pauses in breathing (apnoea) during sleep.
- Frequent nocturnal awakenings, non‐restorative sleep, morning headaches, and excessive daytime sleepiness.
- Patients with OSA often describe difficulty with attention and concentration, mood disturbance
Diagnosis
Diagnostic confirmation of obstructive sleep apnoea is performed by a sleep medicine specialist. You can ask your GP about this.
OSA and other health problems
In addition to its possible impact on quality of life, some studies have shown that people with OSA are at greater risk of developing the following health conditions:
- Hypertension (high blood pressure)
- Heart disease
- Stroke
- Type 2 diabetes
- Depression
- Irregular heart beat (arrhythmia).
Due to feeling sleepy throughout the day there can be a propensity to fall asleep while driving, which is obviously very dangerous.
Treatment
OSA needs to be managed firstly through lifestyle changes, often in combination with other treatments.
Lifestyle and behavioural changes
In cases of mild OSA, lifestyle changes may lead to improvement in the condition. Changes include:
- Weight loss – as even a small loss in weight can improve symptoms
- Avoiding alcohol for at least a few hours prior to going to sleep
- Avoiding sleeping tablets or tranquillisers
- Taking measures to assist sleeping on one’s side rather than on one’s back, as OSA can often be worse when sleeping on the back
- Quit smoking
- Regular exercise.
Treatment of OSA in Adults by Physicians and Surgeons
Continuous positive airways pressure (CPAP) is the most common treatment for obstructive sleep apnoea. It involves the use of a pump which delivers low pressure air into the airways via tubing and a mask fitted to the nose. It is worn during sleep and delivers enough pressure to keep the airway open during sleep. Many people find they feel much better within a few days of commencing CPAP as they get the benefit of deep restorative sleep that they previously lacked.
How Your Dentist Can Help – Oral Appliance Therapy
Mandibular advancing oral appliances (OAm) are usually effective options and can be made by your dentist. OAm are intended to hold the mandible and/or the associated soft tissues forward, resulting in opening the upper airway. These may be used for treatment of mild to moderate OSA and for treatment of patients with severe OSA who are unwilling or unable to use PAP therapy.
OAm are considered the first line of treatment for patients with OSA that prefer an oral apliance over PAP and for those patients that do not respond to PAP therapy. While typically well tolerated, it should also be noted that not all patients with OSA will respond to OAm treatment, with this form of therapy reported to be completely effective in 36% to 70% of OSA cases.