Attention Family Physicians

It has been estimated that nearly half of the American population snores and yet snoring, which has been linked causally to carotid artery atherosclerosis , is still considered no more than a social nuisance. Obstructive sleep apnea (OSA), which affects 20 million people in the United States alone, has been causally related to heart disease, hypertension, stroke, diabetes, obesity, sexual dysfunction and excessive daytime sleepiness. With obesity reaching epidemic proportions, the numbers will increase dramatically in the years to come.

Because of the medical ramifications of snoring and sleep apnea, recognition and management of snoring and OSA are the responsibility of every member of the health professions. Family physicians and family dentists, individually and working in concert, have a unique relationship with their patients – that being a close personal relationship that is not shared by any of the specialties. This interpersonal bond carries with it a special responsibility to recognize the medical and social problems of snoring and sleep apnea.

While continuous positive air pressure (CPAP) is still the primary treatment modality for OSA, dentistry now offers an accepted alternative in the form of an oral appliance for those patients who would rather not use CPAP and/or those who tried but cannot tolerate the CPAP.

A practice parameters paper was published in the journal Sleep in 2006 that stated

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow‐up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur.

Oral appliance therapy (OAT) provided by a dentist who has received post-doctoral education in sleep medicine involves the use of a custom designed dental mouthpiece, much like an orthodontic appliance, worn during sleep. Oral appliances maintain the mandible in a forward position to prevent the collapse of the tongue and pharyngeal soft tissue maintaining airway patency during sleep.

Family physicians play a primary role in the management of care for their patients.
Hopefully this blog post will provide additional information that will be useful in managing treatment options for patients who snore, have observed cessation of breathing during sleep, are hypertensive and who exhibit excessive daytime sleepiness.

Dr. Barsh