Obstructive sleep disorder /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Obstructive sleep disorder /certified fixed orthodontic courses by Indian dental academy

  1. 1. GREETINGS FROM YENEPOYA DENTAL COLLEGE INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com Indian Dental Conference www.indiandentalacademy.com 2008, Mangalore
  2. 2. OBSTRUCTIVE SLEEP APNEA – A Dentist’s Perspective Dr Varghese K Paulose Department of Orthodontics Yenepoya Dental College Mangalore Under the Guidance: Dr Rohan Mascarenhas, Professor Dr Akhter Husain, Professor & H.O.D www.indiandentalacademy.com
  3. 3. INTRODUCTION  Greek word apnea, which means "without breath."  serious sleep disorder  stop breathing for 10 to 30 seconds at a time  short stops in breathing can happen up to 400 times every night www.indiandentalacademy.com
  4. 4. INTRODUCTION  Obstructive Apnea-a cessation of airflow-at least 10 s w/ continued effort to breathe  Central Apnea-apnea w/ no effort to breathe  Mixed Apnea-apnea begins as central but towards end there is effort to breathe without airflow www.indiandentalacademy.com
  5. 5. RISK FACTORS www.indiandentalacademy.com
  6. 6. RISK FACTORS  Excessive weight gain  accumulation of fat on the sides of the upper airway causes it to become narrow and predisposed to closure when the muscles relax  Age  Loss of muscle mass is a common consequence of the aging process  Men have a greater risk for OSA  Male hormones can cause structural changes in the upper airway www.indiandentalacademy.com
  7. 7. RISK FACTORS  Anatomic abnormalities, such as a mandibular retrognathia  Enlarged tonsils and adenoids, the main causes of OSA in children  Family history of OSA, although no genetic inheritance pattern has been proven  Use of alcohol and sedative drugs, which relax the musculature in the surrounding upper airway www.indiandentalacademy.com
  8. 8. RISK FACTORS  Smoking, which can cause inflammation, swelling, and narrowing of the upper airway  Enlarged tongue - Hypothyroidism, Acromegaly, Amyloidosis, Vocal cord paralysis, Post-polio syndrome, Neuromuscular disorders, Marfan's syndrome, and Down syndrome  Nasal congestion While obesity is clearly a risk factor for sleep apnea, sleep apnea is www.indiandentalacademy.com multi-factorial and occurs among people in all weight category.
  9. 9. PATHOPHYSIOLOGY www.indiandentalacademy.com
  10. 10. PATHOPHYSIOLOGY  tissue laxity and redundant mucosa  anatomic abnormalities  decreased muscle tone with REM sleep  airway collapse www.indiandentalacademy.com
  11. 11. PATHOPHYSIOLOGY  Desaturation  Arousal with restoration of airway  Sleep fragmentation leading to hypersomnolence www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. SYMPTOMS  Loud snoring  Excessive daytime sleepiness  Falling asleep easily and sometimes inappropriately  High blood pressure  Other cardiovascular complications  Morning headaches  Memory problems  Feelings of depression  Reflux  Nocturia  Impotence www.indiandentalacademy.com
  14. 14. OSAHS – Diagnosis  The following questions should be asked whenever a diagnosis of OSAHS is being considered  Is the patient falling asleep regularly against their will?  Is this patient often sleepy whilst driving?  Is this patient experiencing difficulties at work because of excessive sleepiness?  Is surgery for snoring being contemplated? www.indiandentalacademy.com
  15. 15. THE EPWORTH SLEEPINESS SCALE  How likely are you to doze off or fall asleep in the following situations in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation. 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing www.indiandentalacademy.com
  16. 16.  Situation Chance of Dozing  Sitting and reading  Watching TV  Sitting inactive in a public place (e.g.. a theatre or a meeting)  As a passenger in a car for an hour without a break  Lying down to rest in the afternoon when circumstances permit  Sitting and talking to someone  Sitting quietly after a lunch without alcohol  In a car, while stopped for a few minutes in traffic  TOTAL (max. 24) www.indiandentalacademy.com
  17. 17. OSAHS – Diagnosis  Epworth Sleepiness Scale – a validated method of assessing the likelihood of falling asleep in a variety of situations   Mild daytime sleepiness – ESS 11 – 14  Moderate daytime sleepiness – ESS 15-18   Normal – ESS <11 Severe daytime sleepiness – ESS >18 Correlation between ESS and OSAHS is relatively weak, but gives a guide to the patients perception of his/her sleepiness www.indiandentalacademy.com
  18. 18. OSAHS – Diagnostic Tools  Full Polysomnography    Costly and complex Investigation of choice for a minority of patients Limited sleep studies  Cost effective, convenient for patients, speeds up the investigation pathway  Overnight sleep studies  A good screening tool www.indiandentalacademy.com
  19. 19. Overnight Polysomnography  Electro-encephalography (EEG) - brain wave monitoring  Electromyography (EMG) - muscle tone monitoring  Recording thoracic-abdominal movements - chest and abdomen movements  Recording oro-nasal airflow - mouth and nose airflow  Pulse oximetry - heart rate and blood oxygen level monitoring  Electrocardiography (ECG) - heart monitoring  Sound and video recording www.indiandentalacademy.com
  20. 20. Overnight Polysomnography www.indiandentalacademy.com
  21. 21. Polysomnographic Criteria For OSA Criteria Adults Children (one to 12 years of age) Apnea-Hypopnea Index* >5 >1 Minimum Oxygen Saturation (%) <85 <92 The apnea- hypopnea index is the average number of apneas and hypopneas per hour of sleep www.indiandentalacademy.com
  22. 22. OSAHS - Severity  Measured using the apnoea/hypopnoea index (AHI) or the respiratory disturbance index (RDI)  Mild – AHI 5 – 14 / hour  Moderate – AHI 15 – 30 / hour  Severe – AHI > 30 / hour www.indiandentalacademy.com
  23. 23. OSAHS – Treatment  Behavioural interventions  Non-surgical interventions  Surgical interventions www.indiandentalacademy.com
  24. 24. OSAHS – Treatment Behavioural interventions  May be sufficient in simple snorers or in those with very mild OSAHS and few symptoms  Weight loss in obese patients  Alcohol and sedatives should be avoided  Non-sleepy snorers should be discouraged from sleeping on their backs www.indiandentalacademy.com
  25. 25. OSAHS – Treatment CPAP  Pneumatic splint to maintain upper airway patency throughout all phases of sleep  Treatment of choice  Improves subjective and objective sleepiness, cognitive function, vigilance, mood and quality of life measures.  Best results are obtained in those with an AHI of >15  Side effects: epistaxis, sinusitis, rhinitis, dryness of the nasal passages, nasal bridge sores, claustrophobia, abdominal bloating, mouth leaks and noise www.indiandentalacademy.com
  26. 26. Continuous Positive Airway Pressure (CPAP) www.indiandentalacademy.com
  27. 27. OSAHS – Treatment Surgical interventions  Uvulopalatopharyngoplasty (UPPP) – poor and unpredictable  Tonsillectomy  Tracheostomy  Mandibular advancement  Bariatric surgery  Nasal surgery www.indiandentalacademy.com
  28. 28. Uvulopalatopharyngoplasty www.indiandentalacademy.com
  29. 29. Maxillo-mandibular advancement www.indiandentalacademy.com
  30. 30. OSAHS – Oral Appliances  adjustable and nonadjustable  Anterior tongue repositioners  Mandibular posturing devices  Soft palate or uvula lifting devices www.indiandentalacademy.com
  31. 31. Anterior Tongue Repositioners  advances the tongue  tongue & mandible together with adjacent soft tissue  increases the posterior airway space  increases the activity of the genioglossal & lateral pterygoid muscles  effects a stretch induction of the pharyngeal motor system www.indiandentalacademy.com
  32. 32. Tongue- Retaining Devices (TRD) www.indiandentalacademy.com
  33. 33. Mandibular Posturing Devices  Also alters position of the hyoid and modify the hypopharyngeal airway space www.indiandentalacademy.com
  34. 34. Nocturnal Airway-Patency Appliance (NAPA) www.indiandentalacademy.com
  35. 35. Herbst Appliance Standard plunger-tube www.indiandentalacademy.com Telescopic connector
  36. 36. Klearway Appliance www.indiandentalacademy.com
  37. 37. Silicone Positioner Appliance www.indiandentalacademy.com
  38. 38. Other Appliances www.indiandentalacademy.com
  39. 39. Soft Palate or Uvula Lifting Devices  reduce soft tissue vibrations that result in snoring www.indiandentalacademy.com
  40. 40. Best????  Although there are logical clinical reasons for using different appliances, there is not enough scientific evidence for the clinician to determine which appliance is most likely to improve symptoms for a given patient www.indiandentalacademy.com
  41. 41. Consequences of untreated OSAHS  Six fold increase in RTA (20% due to sleepiness at the wheel)  Impairment of cognitive function  Impairment of mood  Personality changes  Reduction in quality of life  Impaired relationships  Increased risk of hypertension, IHD and strokes www.indiandentalacademy.com
  42. 42. Conclusion  Dental professionals can, and should, play an active role in  screening patients for the disease &  providing oral appliance therapy (OAT) when a sleep specialist physician has prescribed it www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com