Fortunately, dental professionals are at the front of the line to spot symptoms and treat the condition.  

1. You can spot symptoms with a routine examination

There are a variety of Obstructive Sleep Apnea symptoms that a dentist and/or Hygienist can identify with a simple look into the airway during a routine examination. Common “red flags” for apnea and/or obstructed airway, that are found during a routine dental visit, are as follows:

• a large/long uvula
• an oversized and “scalloped” tongue
• large tonsils
• signs of bruxism
• Acid Reflux (G.E.R.D.)

You may want to ask your patients about their sleep history if you observe any of these tell-tale signs of the condition. This can easily be done with a few extra questions on screening forms or during a patient history update.

2. It’s Underdiagnosed

It’s estimated that around 80% of sleep apnea cases go undiagnosed. Many patients find themselves treating visible symptoms, sleep aids for daytime sleepiness and Medication for High Blood Pressure, before considering a sleep test. This leads to a tragically high mortality rate for those afflicted with heart disease or stroke, as the condition worsens quietly over time.

3. It’s Potentially Life-Threatening

Aside from the general decrease in quality of life for these patients, there is absolutely the risk of death from multiple health issues if the condition is left untreated over a period of time. We know that OSA patients are at a particular risk for passing due to:

• OSA causes one to stop breathing multiple times per night which causes blood oxygen levels to go down, causing one’s heart rhythm to flutter. This is a heart complication that occurs at the time of sudden cardiac death.
• OSA causes low oxygen levels and high blood pressure, both can increase the risk of future stroke if left untreated.

Research has shown that patients with obstructive sleep apnea are more likely to experience sudden cardiac arrest between the early hours of 12am-6am. (1)

Another factor worth considering is how the cognitive impairment that sleep apnea causes puts people in danger with everyday task. In fact, The National Highway Traffic Safety Administration estimates that drowsy driving was responsible for 72,000 crashes, 44,000 injuries, and 800 deaths in 2013.

4)  Dentists Can Provide OSA Therapy Via Custom Oral Appliances.

For many, over the counter snoring solutions such as chin straps and snoring guards may seem appealing due to their cheaper cost and their ability to treat snoring on some level. These OTC solutions can actually cause more harm than good and have not been proven to effectively treat OSA. It is always recommended to have a trained Dentist overseeing the oral appliance treatment process. Dentists are able to measure effectiveness, titrate the appliance and help manage morning occlusal techniques. Oral Appliance Therapy is an effective and non-invasive treatment for those with Mild-Moderate OSA and for those who cannot tolerate or refuse to use CPAP.

It’s worth noting that ONLY dentists can provide a custom oral appliance that can open the airway with vertical and/or forward positioning. There are oral appliances that can treat OSA and bruxism as well.

5)  Men, Women, and Children all Present Symptoms Differently

Women and children present certain symptoms of sleep apnea that, unfortunately, leads to both groups being underdiagnosed and misdiagnosed regularly (even more so than the typical demographic of older males that suffer from the condition).

As far as statistics go, men are around twice as likely as women to have sleep apnea, and it’s estimated that up to 10% of children have the condition.

• Men tend to be able to fall asleep anywhere and anytime, frequent trips to the bathroom at night, general fatigue and extremely loud snoring.
• Women are more likely to present symptoms of insomnia, anxiety, depression and daytime sleepiness. Women have been known to benefit from more deep sleep than men and their circadian cycles usually run shorter than men’s. A UCLA study from 2013 found that women with apnea are more affected in the areas of the brain that regulate decision-making and moods.
• Children tend to present symptoms with mouth breathing, snoring, enlarged tonsils and adenoids, night sweats and bed-wetting. Children with untreated OSA have also displayed difficulty with concentration, poor attention spans and behavioral problems causing poor performance at school. Sadly, studies have suggested that as many as 25% of children diagnosed with some form of attention-deficit hyperactivity disorder may actually have symptoms of obstructive sleep apnea.

As dental professionals, it’s important to look beyond the teeth when examining patients in any situation, and OSA is no exception. You can read more about how OSA affect women and children on our blog.

Conclusion

The airway is a vulnerable and important piece of anatomy, essential to getting proper oxygen levels to your body and brain. To be properly examined, it must be observed and understood in relation to other body systems, including the territory of dental professionals.

The first step is recognizing that there’s an issue. As dentists, you can do so much to help your patients suffering from a serious health defect that may not have been on your radar. Let’s look past the teeth, into the airway and save lives – Giving patients something to really smile about: being alive and well rested.

But would you keep yourself from driving for being a bit too drowsy? When you’re just tired enough, and in a second you find your eyes fluttering a bit too much, and in a moment of terror, you pull your head up after finding yourself dozing off. According to the Center of Disease Control (CDC), 1 in 25 of you, have been in this exact situation within the past month alone.

For many, these dangerous, but dismissible few seconds (or minutes) may be symptomatic of something more serious, and something that will have a long term, far reaching effect on their health.

The Facts

The reality is, much of this impaired driving may very well be caused by Obstructive sleep apnea, a condition infamous for perpetuating daytime sleepiness and creating a variety of cognitive issues such as slow reaction times and memory problems. Of course, this could lead to the inability to stay awake during seemingly active task (being examined in a doctor’s office, for example).   

According to the CDC, staying awake for 18 hours straight gives you the equivalent driving ability as when you have a blood alcohol level of .05 (.08 is considered legally drunk). In another parallel to drinking, studies also show that excessive sleepiness decreases our judgment and increases risk taking. Sufferers’ of sleep apnea, with the previously mentioned daytime sleepiness and cognitive impairment, are particularly at risk for feeling like this on the road. No one should be expected to function when they’re impaired on that level, and anyone in a different situation feeling impaired that way would have their keys taken out of their hands.

Tragic Cases 

You don’t have to look far to find horrifying, real world, examples of the tragedy that driving under the influence of OSA can bring. The National Highway Traffic Safety Administration estimates that drowsy driving was responsible for 72,000 crashes in 2013, but you can see some examples of prominent, recent cases of commercial drivers being negligent due to OSA here.

Sept. 2013: Fatigued Greyhound driver flips bus, severely injuring 5. Driver was given previous recommendation to seek out a sleep study. Driver did not take test and was later found to have Obstructive Sleep Apnea after a court ordered sleep test.

Oct. 2014: Engineer for the Metro-North rail suspected of having sleep apnea fell asleep as the train was speeding through a tight curve, killing 4 and injuring more than 70.

Sept. 2016: New Jersey train crashed into Hoboken station after bumping the post at the end of the track, killing one and injuring 110. Engineer was known to have issues with OSA.

Jan. 2017: Long Island Rail Road commuter train crashed into Atlantic Terminal Station in Brooklyn after failing to stop at the end of the line, injuring 108.

In addition to having a laundry list of horrible health effects on the individual, driving while leaving this condition untreated is a public safety issue that could easily be curbed with some further awareness and action.

Encourage anyone you believe to be at risk to get sleep tested. Everyone deserves to be safe on the road.

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This percentage is higher in women, which is mainly due to the fact that a) most OSA sufferers are men, and b) the symptoms of OSA present differently in men than women. Due to unfortunate profiling, women are also more likely to be prescribed prescription medications for tertiary symptoms of OSA (depression, anxiety, etc) rather than a sleep study for further testing.

To put the issue into perspective, while the ratio of OSA in men to women is around 8:1, men are only around twice as likely to actually be afflicted. Obviously, there’s a discrepancy here. Below are some common ways that the symptoms of OSA differ in the sexes, and some symptoms that are common in both, but have the tendency to lead to the misdiagnosis of other conditions.

If you recognize any of the following symptoms in your patients, it may be time to ask about their sleep history.

The Difference in Symptoms:

• Snoring is usually much lighter
• Breathing problems during sleep tend to be more subtle
• Women tend to have lower apnea/hypopnea indexes (AHI). Apnea events are usually shorter in duration and frequency than men are.

Misdiagnosed Symptoms:

• Insomnia

• Restlessness in legs
• Exhaustion or fatigue
• Depression
• Daytime sleepiness
• Morning headaches
• Concentration or memory difficulties
• Frequent urination at night
• Heartburn at night
• Night sweats
• Lack of energy during day
• Uncontrollable high blood pressure

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