[{"@context":"https:\/\/schema.org\/","@type":"BlogPosting","@id":"https:\/\/nqsurgicaldentistry.com.au\/snoring-osa-explained\/#BlogPosting","mainEntityOfPage":"https:\/\/nqsurgicaldentistry.com.au\/snoring-osa-explained\/","headline":"Snoring & Sleep Apnoea (OSA) Explained","name":"Snoring & Sleep Apnoea (OSA) Explained","description":"[et_pb_section fb_built=”1″ fullwidth=”on” custom_padding_last_edited=”on|desktop” _builder_version=”3.22″ background_color=”#ffffff” custom_padding_tablet=”0px|0|0px|0||” custom_padding_phone=”” hover_enabled=”0″ custom_css_main_element=”z-index: 0;” transparent_background=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” sticky_enabled=”0″][et_pb_fullwidth_header title=”Snoring & Sleep Apnoea” button_one_text=”Book a Consultation” button_one_url=”https:\/\/nqsurgicaldentistry.com.au\/contact-us\/” background_overlay_color=”rgba(255,255,255,0)” module_id=”top-header” _builder_version=”3.16″ title_font_size=”25px” 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[…]","datePublished":"2016-06-19","dateModified":"2021-04-17","author":{"@type":"Person","@id":"https:\/\/nqsurgicaldentistry.com.au\/author\/admin\/#Person","name":"admin","url":"https:\/\/nqsurgicaldentistry.com.au\/author\/admin\/","image":{"@type":"ImageObject","@id":"https:\/\/secure.gravatar.com\/avatar\/7e8332d597554647ad1a751e441d0749?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/7e8332d597554647ad1a751e441d0749?s=96&d=mm&r=g","height":96,"width":96}},"publisher":{"@type":"Organization","name":"Dr Colin 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_builder_version=”3.27.4″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” use_border_color=”off” custom_margin=”-67px|||||”]Snoring key points:Snoring is extremely common resulting from partial collapse of the soft tissues around the upper airway and is often associated with OSASnoring is a frequent cause of bedroom-stress due to difficulty of partner sleepingSnoring often results in a sore throat and dry mouthSnoring is made worse by drinking alcohol and taking sedativesReports indicate 95% reduction in snoring using an oral appliance called a mandibular anterior positioning splintObstructive Sleep Apnoea (OSA) key points:OSA is a potentially serious condition in which people stop and start breathing repeatedly during sleepOSA affects 1 in 3 peopleThere is an established link between OSA and several serious medical conditions including diabetes, obesity, depression, raised blood pressure, heart disease and strokeOSA is most common in overweight men but can be found in all ages and both\u00a0gendersOften patients with OSA are unaware of their conditionPatients with OSA often feel tired during the day and are more likely to suffer workplace related accidents and motor vehicle accidents than other peopleWhat is OSA?Obstructive sleep apenoea or OSA is when the airway behind the tongue, called the posterior airway space, collapses due to muscular relaxation in some patients while they sleep.\u00a0 When taking a breath, the soft tissues of the airway either partially or completely collapse, obstructing the airway which also causes snoring.A partial obstruction results in reduced airflow, known as hypopnoea and complete obstruction leads to an entire cessation of airflow, known as apnoea.\u00a0 From the anatomical diagram below, the tongue falls back blocking off the airway.An oral splint can be worn to maintain the forward position of the lower jaw (mandible), and this helps to maintain tongue support preventing the collapse of the soft tissues closing off the posterior airway space. \u00a0The referred splint is called a Mandibular Anterior-positioning Splint (MAS).The X-rays show how on the left there is only a very narrow airway (4.25mm) while the lower front teeth remain behind the upper teeth in what is a normal position.\u00a0 In the X-ray on the right when the lower teeth are brought forward, the mandible that has the tongue attached to it, brings the tongue forward and in doing so, it opens up space behind the tongue, (posterior airway space) increasing the space to 12mm.\u00a0 This is the basis of the success accredited to MAS as a treatment for OSA and snoring. The effect of hypopnoea or apnoeaWith reduced, or cessation of breathing, the cells of the body quickly use up the available oxygen in the blood leading to a fall in the oxygen saturation of blood and an increase in the level of carbon dioxide carried in the blood.Usually, it is the small increases in carbon dioxide that drives the body to breathe.\u00a0 However, if soft tissue obstructs the airway, breathing cannot take place and the patient\u2018s effort to\u00a0breathe results in partially waking them with a feeling of panting, gasping or choking.\u00a0 This partial waking from sleep is described as an arousal.\u00a0 This lightening of sleep can lead to complete sleep disruption or simply result in a poorer quality of sleep.\u00a0 This regular arousal throughout the night results in inadequate rest for the body\u2019s healing, repair, and refreshment to take place.These periods of hypopnoea or apnoea can occur many times every hour.\u00a0 With repeated apnoea, sleep is so badly affected that patients fail to recharge their batteries at night and become increasingly tired, irritable and find they have deficient concentration during the day.What are the symptoms of OSA?The most common symptom of OSA is snoring.\u00a0 Often patients who suffer from OSA snore very loudly, and this can result in pressure being placed on personal relationships with the sufferer having to sleep in a separate bedroom.OSA can also lead to the patient waking up feeling as if they are choking or gasping for air.\u00a0 OSA sufferers frequently perform erratic leg movements while asleep and may wriggle their legs constantly during the day, a condition known as \u201crestless legs syndrome\u201d.Patient with OSA often complain of daytime tiredness.\u00a0 They may fall asleep after lunch, when sitting reading, while in a cinema or other public places, even in front of the computer or when having a conversation.\u00a0 Some even fall asleep at the wheel when driving.\u00a0 Research has shown that OSA sufferers are four times more likely to have a road accident than other people.Who suffers OSA?People of all ages and both genders can suffer from OSA.\u00a0 It can affect healthy fit individuals but more often affects middle-aged obese people and commonly found in men.\u00a0 However, women after menopause are also frequently affected.How to diagnose OSA?The only reliable method of diagnosis is through a \u201csleep study\u201d, also called \u201cpolysomnography\u201d.\u00a0 This can be arranged in a sleep medicine laboratory or at home, both through referral to a sleep medicine specialist or through your GP.These studies can be performed with different levels of equipment from a level 1 study measuring every parameter to a level 2 study measuring a large number of parameters, both being conducted in a sleep laboratory.\u00a0 Level 3 and 4 studies can be arranged at home in your bed as the later\u00a0studies can often be more representative of the normal situation.Once the study has been completed and all the data collected digitally, it can be analysed by a sleep medicine specialist and a \u201cpolysomnography report\u201d is written that will detail the severity of sleep disorder from which you are suffering.A questionnaire has been developed to help predict those patients most likely to suffer from OSA.\u00a0 The STOP-BANG questionnaire has been found to be effective. The letters STOP-BANG indicate the risk factors.S\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Snore: Do you snore loudly?T\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tired:\u00a0 Are you tired and sleepy during the day?O\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Observed:\u00a0 Has anyone observed you stop breathing when you sleep?P\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pressure:\u00a0 Are you being treated for or do you suffer raised blood pressure?B\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 BMI:\u00a0 Is your BMI over 35?A\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Age:\u00a0 Are you over 50 years old?N\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Neck circumference:\u00a0 Is your NC >40cm?G\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gender:\u00a0 Are you male?If STOP-BANG is >3, then there is a high chance of OSA existing and if <3, OSA is unlikely.How is OSA treated?Weight lossOften the first suggestion is for obese patients to try to loose weight.\u00a0 Even 10% reduction in body weight can have a profound effect on the degree of OSA or hypopnoea resulting in a 26% reduction in the respiratory disturbance index.\u00a0\u00a0 However, weight loss is not always accompanied by reduced severity of OSA or snoring.CPAPFollowing weight loss, there are two ways to treat OSA.\u00a0 Historically, continuous positive airway pressure (CPAP) has been used.\u00a0 This relies on the patient tolerating one of many mask designs to cover either the nostrils alone, the entire nose or the nose and mouth. These masks allow air to be blown into the airway under positive pressure to inflate the airway and stop it collapsing.\u00a0 This treatment method has been recorded as effective, however, many patients find the masks difficult or uncomfortable to wear and find they wake during the night with the mask not fitting correctly due to rolling onto the side and a noisy escape of air taking place.\u00a0 This results in poor compliance in some patients.Oral devicesOver recent years, oral devices have been developed to hold the lower jaw forward to a degree that reduces the tendency of the tongue to relax back against the posterior airway wall sealing off the airway.\u00a0 These oral appliances are called various names; most commonly they are referred to as mandibular anterior positioning splints (MAS), of which there are many designs.\u00a0 No single design is superior to all others.\u00a0 Many have benefits and may suit a particular patient.Many designs of MAS exist and a number work well in different patients, however for the best result, they must be custom made for the patient to achieve a stable fit ensuring the appliance cannot move on the teeth during the night.\u00a0 This is one of the main shortcomings of \u201coff the counter\u201d appliances that can be purchased from stores.\u00a0 They must also be adjustable allowing the degree of anterior positioning of the lower jaw to be accurately set to the point at which snoring and OSA cease.\u00a0 It is the latter point that is most essential from a health point of view.\u00a0\u00a0 Those appliances bought from stores are generally not adjustable, another one of many short-comings.Some science to back it up!Research now supports the use of MAS for the treatment of snoring and mild to moderate OSA (Fernanda. J, 2009).\u00a0 CPAP generally remains the gold standard for the treatment of severe OSA but not all patients are able to tolerate CPAP.\u00a0 For those patients research is now suggesting that even in severe OSA, MAS therapy can be successful (Katz. J, 2015).A landmark research study clearly demonstrated that \u201cstate-of-the-art\u201d oral appliances were overall equivalent to CPAP in terms of improving blood pressure, quality of life, sleepiness and the apnoeic-hypopnoeic index (AHI) and was considered superior to CPAP in 4 of 8 quality of life measurements (Craig 2013).\u00a0 This suggests that MAS should not only be used for patients suffering from mild to moderate OSA, and for those in the group suffering from severe OSA but who cannot use CPAP.\u00a0 The performance of MAS in the treatment of OSA in all patients should, therefore, be considered as good as CPAP and, therefore, suitable as a first line therapy equally as effective as CPAP.Avoiding OSA?To reduce the chance of suffering from OSA, patients who have a tendency to snore should abstain from smoking, minimise alcohol intake, particularly in the evening, as this further relaxes the muscles and contributes to snoring and OSA.\u00a0 They should also avoid caffeine at night and avoid eating a large meal late in the evening.OSA patients should avoid taking sleeping tablets, but if they have been prescribed, then the GP must be involved in any decision to change your medication regime or discontinue any medication.What possible side effects exist?Some people experience a change in the position of some of their teeth.\u00a0 This varies from patient to patient.\u00a0 These changes cannot be predicted, and some changes can be undesirable but on questioning, patients considered these occlusal changes as acceptable in view of the positive results experienced in treating snoring and OSA.Temporo-mandibular disorder has also been reported in some patients wearing MAS.\u00a0 Approximately 12% of patient treated with MAS experienced this side effect (Lowe. A, 2007)\u00a0This, therefore, supports the need for a 6-12 monthly review of patients receiving treatment for OSA or snoring using MAS therapy.contact the friendly team at NQ Surgical Dentistry today on\u00a0(07) 4725 1656 or call in to see us at\u00a0183 Kings Rd, Pimlico QLD 4812ReferencesFernanda et al. J Clin Sleep Med 2009: 5(3)Katz et al, J Clin Sleep Med 2015: 11(7); 773-827. Clinical practice guideline for the treatment of obstructive sleep apnoea and snoring with oral appliance therapy: An update for 2015Craig et al. Health outcomes of CPAP versus oral appliance treatment for obstructive sleep apnoea. Am J Resp & Crit Care Med February 2013Dr Alan Lowe \u2013 Presentation at the Meeting of the American Academy of Dental Sleep Medicine 2007, Minneapolis, USA[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|tablet” admin_label=”Services” _builder_version=”3.22″ custom_margin=”|||” custom_padding=”0|0px|0|220px|false|false” custom_padding_tablet=”|0%|40px|0%|false|true” custom_padding_phone=”” border_radii=”||||20vw” box_shadow_style=”preset1″ box_shadow_vertical=”40px” box_shadow_blur=”60px” box_shadow_color=”rgba(0,64,135,0.06)”][et_pb_row use_custom_gutter=”on” _builder_version=”4.0.3″ background_color=”#0aaaaf” background_enable_color=”off” width=”100%” max_width=”100%” module_alignment=”right” custom_margin=”|||” custom_padding=”0|0px|0|0px|false|false” use_custom_width=”on” width_unit=”off” custom_width_percent=”100%”][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” 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