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Orthodontics > MS2 - Obstructive Sleep Apnoea > Flashcards

MS2 - Obstructive Sleep Apnoea Flashcards

1
Q

Briefly, what are the 5 stages of sleep?

A

REM and non-REM stage 1-4

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2
Q

In general, approximately how much of the Australian population have OSA, and what is the prevalence through age groups?

A

approx. 5% in general

3.6-5% in 18-44
12-13% in 45+

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3
Q

What are some sleep disorders that a dentist and orthodontist may be able to help manage?

A

Sleep breathing disorders: OSA, snoring
Sleep related movement disorders: Sleep Bruxism

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4
Q

Does sleep apnoea pose a significant financial implication to the hospital out of all sleep-related issues.

A

Yes, the tx of sleep apnoea alone cost the hospital system approx. 73% out of all sleep disorders

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5
Q

What are some conditions that OSA increases the risk of?

A
  • Heart failure
  • MI
  • schizophrenia
  • depression/anxiety
  • PTSD
  • angina
  • diabetes
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6
Q

what is the prevalence of snoring and is it more common in males or females?
+ Is snoring the same as sleep apnoea?

A

about 40% of adults - M>F
Snoring does not necessarily = sleep apnoea

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7
Q

What is Central sleep apnoea (CSA) vs Obstructive sleep apnoea (OSA)?

A

CSA - airflow ceases due to a physiological lack of respiratory drive (eg. through spinal cord injury)

OSA - airflow stops due to physical obstruction

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8
Q

What is Apnoea vs Hypopnea?

A

Apnoea - Total cessation of airflow for at least 10 seconds

Hypopnea - reduced airflow for at least 10 seconds accompanied by arousal or drop in oxygen saturation

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9
Q

How do you calculate severity of sleep apnoea, and what is considered mild, moderate and severe for adults vs children?

A
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10
Q

What are some symptoms of sleep apnoea?

A
  • waking up with dry mouth or throat
  • weight gain
  • excessive daytime fatigue
  • forgetfulness
  • irritability
  • poor concentration
  • low mood
  • restless sleep
  • sexual dysfunction
  • insomnia
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11
Q

What are some modifiable and some non-modifiable risk factors for OSA in adults?

A

Modifiable - Obesity, smoking, alcohol, upper airway collapsibility

Non-Modifiable - Male, Older age, Genetic factors

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12
Q

What are some recommendations to reduce sleep apnoea?

A
  • weight loss
  • smoking cessation
  • alcohol cessation
  • sleeping position (not supine)
  • CPAP machine
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13
Q

What are some dental risk factors for OSA?

A
  • high narrow palate
  • narrow dental arches
  • increased anterior face height
  • increased Overjet
  • Retrognathia
  • Large tongue
  • tonnsilar hypertrophy
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14
Q

What are 2 common risk factors for OSA in children?

A
  • Enlarged tonsils and/or adenoids is the most common risk factor
  • Obesity - 50% of obese children present with OSA
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15
Q

Differences between adults and children with OSA

A
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16
Q

Management of OSA in children and what is the biggest concern? (1, 4)

A

failure to thrive is the biggest concern

management:

  • adenotonsillectomy
  • pharmacological agents to reduce lymphoid tissue
  • weight loss if obese
  • CPAP
17
Q

What issue can a CPAP machine cause on children?

A

Reports of maxillary retrusion due to continuous pressure on maxilla preventing it growing forward

18
Q

what roles can the dentist play for patients with sleep apnoea?

A
  • dentists are in a unique position to screen for sleep apnoea as they see their pts regularly
  • dentists also can play a role in management through mandibular advancement appliances → should be done under the guidance of a specialist sleep physician
19
Q

What are some oral signs that may suggest OSA?

A
  • Mallampati Score - Class III or IV
  • Scalloped tongue - tongue pressed against teeth during sleep - 70% OSA, also a sign of sleep bruxism
20
Q

What is a questionnaire which may help in the screening of OSA?

A

STOP-BANG Questionnaire - 4 questions, 4 observations

A score of 3 or higher are suggestive of risk of OSA

S - snoring? is the snoring as loud or louder than talking volume

T - Tiredness - do you wake up tired, do you get tired during the day?

O - Observed Apnoeas - have you felt / has anyone told you

P - Hypertension - do you have high BP, or are you on medication for high BP?

B - BMI - overweight/obese?

A - Age - >50 years?

N - Neck circumference >40cm?

G - gender - male?

21
Q

How can you screen children for signs of OSA?

A
  • History of snoring, daytime sleepiness, difficulty concentrating, ADHD may be suggestive of OSA
  • paediatric sleep questionnaire (free to download)
  • Assess size of tonsils
  • skeletal risk factors - Retrognathic mandible, narrow maxilla
22
Q

how can sleep apnoea be diagnosed?

A

Polysomnography test

23
Q

What does the dental therapeutic guidelines say about the management of OSA?

A
  • dentists have an important role in the multidisciplinary management of OSA, including diagnosis of skeletal abnormalities (. eg. retrognathic mandible, narrow and high maxilla) and the construction of advancement splints
  • However, the treatment needs to be done in association with a specialist respiratory physician
  • Not all snoring is a sign of OSA
  • Use of oral devices to treat snoring without medical investigation is not appropriate → refer for medical assessment first
  • *Pts with sleep apnoea are at increased risk of respiratory arrest from sedation and GA → should be undertaken in a hospital
24
Q

When is it appropriate to use Mandibular advancement splint in pts with OSA who are children vs adults?

A

Children - Only if there is a skeletal problem

Adults - mandibular advancement splints can be used in adults with mild to moderate OSA who don’t tolerate CPAP

25
Q

considerations about Mandibular advancement devices / splints (4)

A
  • better tolerated than CPAP
  • less effective in more severe cases
  • can cause changed to occlusion over time
  • Adults need to be dentate for most appliances
26
Q

If all other tx fails, what options can be taken?

A

Orthognathic surgery - maxillary and mandibular advancement surgery

Orthodontics (15 decks)

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