There has been a recent increase in sleep-related breathing disorders (SRBD) awareness among the medical community. These conditions are described as disruptions in standard breathing patterns and are potentially severe when left undetected and undiagnosed. These conditions can affect the body in many ways, from cardiovascular health to metabolic diseases, and even dental issues, and more. In 2017, the ADA’s House of Delegates included dentists in the spectrum of medical providers that can diagnose SRBD, allowing more people to become aware and treat their conditions before they become fatal.
Most Common SRBD
Several conditions can be identified as sleep-related breathing disorders, which are all caused by the anatomical collapse and alteration of the body’s respiratory control mechanisms. These disorders include:
- Upper airway resistance syndrome (UARS)
- Obstructive sleep apnea (OSA)
There are two types of sleep apnea, obstructive and central sleep apnea, which is less common. OSA has been proven to be the most troublesome, and if left untreated, it can lead to potentially fatal diseases in adults. In children, it can cause cardiovascular issues, behavioral problems, and impaired growth.
Obstructive Sleep Apnea
This condition occurs when the muscles in the back of the throat relax during sleep. These muscles are in charge of supporting the soft palate, which is a triangularly shaped flap of skin that hangs in the back of the throat, often called a uvula, the tonsils, and sidewalls of the throat as well as the tongue. When the muscles relax, they narrow the airway that allows air to enter the lungs, which can lower oxygen levels in the blood. This will cause the brain to signal to the body that the airway needs to open, often jolting people awake with a snort, choke, or gasp in the middle of the night, often several times each hour impairing the body’s ability to attain deep, restful sleep.
Adults with OSA can experience a heightened risk of high blood pressure (hypertension), as well as recurrent heart attacks, stroke, and abnormal heartbeat, also known as atrial fibrillation. People with sleep apnea will often deal with constant daytime fatigue caused by repeated awakenings throughout the night, making restorative sleep impossible. Those who suffer from these sleep-related disturbances are more likely to fall asleep at work or while operating a motor vehicle, increasing their risk of motor or workplace accidents.
Sleep apnea can cause sudden drops in blood oxygen levels leading to an increase in blood pressure and a strain on the cardiovascular system, potentially increasing the risk of hypertension. There’s also an increased risk for people with OSA to suffer from type II diabetes upon developing insulin resistance, as well as metabolic syndrome that includes high cholesterol, blood sugar, and increased waist circumference. The liver is also put under stress with OSA, and liver function tests will often reveal signs of scarring caused by nonalcoholic fatty liver disease. With these conditions, high body weight is usually one of the first signifiers that someone may be suffering from sleep apnea, but it can happen with all body types.
Help from a Dentist
It may seem unlikely, but most people see their dentists more than they see their doctors. This puts dental professionals in a position to identify, screen, and diagnose SRBD, and even a patient’s increased risk of potentially developing and related disorders. Dentists are now being trained in various methods to determine SRBD in patients through a collaborative model, including multiple solutions to help mitigate and treat the associated medical conditions that it may cause.
For children, the dentist will look for suboptimal craniofacial growth and development and monitor them as the child grows, with possible referrals to orthodontic specialists that can intervene with the use of appliances or other methods to mitigate future issues. A child’s screening history and clinical examination will help uncover signs and symptoms of deficient growth or development that could lead to airway issues and increase the future risk of SRBD.
For adults, dentists will screen a patient’s health history to determine the presence of SRBD, including symptoms most often attributed to the conditions like daytime sleepiness, choking during sleep, snoring, and risk factors such as obesity, retrognathia, and hypertension. If signs are present, a dental professional will work in conjunction with physicians to help the patient address the prognosis in a dynamic way to ensure overall health is improved.
Oral Appliance Therapy (OAT)
In some cases of SRBD, dentists can recommend oral appliance therapy or OAT. These custom made appliances can improve SRBD in adult patients when compared to no therapy or placebo devices, and especially for patients who are intolerant of continuous positive airway pressure, or CPAP machines. Dentists are the only medical providers that have the knowledge and ability to provide OAT to patients who may benefit from them. Some patients will need various stages of adjustment to their oral appliance, and some may even require surgery to manipulate the muscles and skin flap in the back of their throats that cause sleep apnea. These situations will be closely monitored with the collaboration of dentists and physicians together to achieve the best possible outcome.
Sleep-Related Breathing Disorders are becoming more prominent in healthcare as they have a wide range of symptoms and can lead to many severe and potentially fatal diseases. Previously people have shrugged off snoring or snorting as nothing more than annoying sleep habits, but experts have linked snoring to SRBD and then to very serious health conditions that are caused by breathing disorders and those that may be co-occurring as well. Thankfully, dentists are equipped to identify, diagnose, and monitor SRBD in both child and adult patients. They have the expertise to offer potential remedies to help patients achieve greater overall health.
If you think you may have SRBD, call your dentist to discuss your symptoms and set up a consultation as soon as possible.