Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DMOP > Obstructive Sleep Apnea > Flashcards

Obstructive Sleep Apnea Flashcards

1
Q

6 RECOMMENDATIONS:
1. We recommend that sleep physicians prescribe —, rather than no therapy, for adult patients who
request treatment of primary snoring (without obstructive
sleep apnea). (STANDARD)
2. When oral appliance therapy is prescribed by a sleep
physician for an adult patient with obstructive sleep apnea,
we suggest that a qualified dentist use a …(GUIDELINE)
3. We recommend that sleep physicians consider prescription
of —, rather than no treatment, for adult
patients with obstructive sleep apnea who are intolerant
of CPAP therapy or prefer alternate therapy. (STANDARD)
4. We suggest that qualified dentists provide oversight—
rather than no follow-up—of oral appliance therapy in adult
patients with obstructive sleep apnea, to survey for dental
related side effects or — changes and reduce their
incidence. (GUIDELINE)
5. We suggest that sleep physicians conduct follow-up sleep
testing to improve or confirm treatment efficacy, rather than
conduct follow-up without sleep testing, for patients fitted
with oral appliances. (GUIDELINE)
6. We suggest that sleep physicians and qualified dentists
instruct adult patients treated with oral appliances for
obstructive sleep apnea to return for periodic office visits—
as opposed to no follow-up—with a qualified dentist and a
sleep physician. (GUIDELINE)

A

oral appliances
custom, titratable
appliance over non-custom oral devices.
oral appliances
occlusal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. Obstructive:
A

absence of airflow despite
respiratory effort- Dentist may treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. Central:
A

absence of airflow & No respiratory
effort (brain control of respiration is
abnormal) –
treated by M.D. with
medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. Mixed:
A

combination of obstructive & central

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

OSA
1. Is not treated in the pre-doctoral or resident
clinics
2. Can be treated by

A

general dentists who are
certified in sleep medicine with knowledge
of Medical Billing. CE coursework is required
to treat Obstructive sleep apnea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. Diagnosis of OSA MUST be made by a
A

licensed physician (NOT a dentist) & a
Polysomnogram (PSG) sleep study must be
ordered by the M.D. as well as treatment
studies.
2. Requires a National Provider Identification
Number (NPI) and dental license to bill for
this medical condition
3. Requires advanced training to TREAT &interpret the sleep studies to determine
efficacy of sleep appliance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

OSA
 is a very common and potentially
life-
threatening medical disorder (i.e. heart
attack, stroke)
 occurs when

A

tissue in the back of the throat
collapses and blocks the airway, reducing the
amount of oxygen delivered to all of your
organs including your heart and brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

 Apnea-

A

cessation of oronasal airflow for > 10
seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

 Hypopnea-

A

decrease in airflow of 50% for
>10 seconds with >3% O2 desaturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

 Apnea Index:

A

the average number of apneas per
hour of sleep (AI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

 Apnea-Hypopnea Index:

A

the average number of
apneas and hypopneas per hour of sleep (AHI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

 Respiratory Disturbance Index:

A

AHI + RERAs
(respiratory effort related arousals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

 Requires Treatment:

A

AHI>5, Respiratory
Disturbance Index is elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

 Oxygen Saturation (SaO2):

A

the fraction of a
total hemoglobin (HB) in the form of HbO2 at
a defined pressure of oxygen (PO2).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q


Partial pressure of arterial Oxygen (PaO2):

A

the part of total blood gas pressure exerted
by oxygen gas. Normal partial pressure of
oxygen in arterial blood is 95-100mmHg. It
is lower in individuals with asthma,
obstructive lung disease & certain blood
diseases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

 NORMAL SaO2 in AWAKE individual:
 SaO2 Desaturation Scale in OSA:
 Mild:
 Moderate:
 Severe:

A

> 93%

85-89%
80-84%
<80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

 Certain individuals with Obstructive Sleep
Apnea will experience decreased Oxygen
saturations causing Hypoxia during sleep.
Decreased SaO2 levels <–% are known to
compromise organ function (i.e. brain and
heart).
 Continued low oxygen levels may lead to
respiratory or cardiac arrest. —
is common

A

80
Atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Epidemiology
1. Affects –% of adult population in
the U.S. (20 million Americans)
2. Male: Female prevalence is –
3. Menopause: Occurs x more
frequently due to progesterone
levels
4. Insomnia: –%
5. Age: increases with — age
6. — Body Mass Index (BMI)

A

4
2-3:1
2x
10
middle
High

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

incidence of snoring
By Age 40:
 –% of Males
 –% of Females
By Age 60:
 –% of Males
 –% of Females

A

40
20

60
40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Snorers : Increased Risk
HTN –x
sudden death –X
CVA’s (stroke) –X
ischemic heart disease –X

A

2
4
10
2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Consequences of OSA
MEDICAL:
(4)

A
  1. DEATH
  2. Cardiovascular -
    HTN, Myocardial
    Infarction (MI), Stroke
    (CVA)
  3. Diabetes, obesity,
    depression
  4. Medical costs - 2.5-
    3x hospital days and
    2x medical costs
    ($3.4 billion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Consequences of OSA
PERSONAL IMPACT:
1. Motor Vehicle
Accidents-corrects
with —
2. Psychosocial/economic
failure - –% fell asleep
at work, –% fired or
demoted.
3. Lost productivity &
workplace accidents:
$150 billion

A

CPAP
34,11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

skipped
Medical eval incudes (7)

A
  1. History and Epworth Sleepiness Scale
  2. Physical exam: neck size, BMI, ENT
    evaluation
  3. Polysomnogram with “split night” titration
    wearing the CPAP mask during 2nd half of
    study
  4. Imaging: dynamic MRI- may be done
  5. Dental Exam:
  6. TMD Exam
  7. Panorex &/or Lateral Tomography or CBCT
    of TMJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

symptoms and signs of OSA
Primary
(3)
Secondary
(9)

A

 snoring
 hypersomnia
 breathing pauses,
choking

 hypertension
 Gastric esophageal
disease (GERD)
 night sweats
 headaches
 nocturia
 decreased libido
and/or impotence
 decreased memory
 Irritability
 Atrial fibrillation

25
Q

symptoms
(5)

A

 Daytime somnolence
 Snoring
 Chronic fatigue
 Neurocognitive
 Dysfunction

26
Q

skipped
role of dentists (6)

A
  1. Recognize OSA symptoms and refer to sleep physician
  2. Manage possible consequences of OSA e.g. Bruxism,
    GERD and oro-facial pain
  3. Ability to recommend the appropriate Mandibular
    Advancement Devices (MADs)
  4. Coordinate with a sleep physician and monitor the
    patients physical and mental health
  5. Able to understand the results of sleep studies
  6. Managing the possible side effects of using MADs
27
Q

Dentists evaluate airway space regularly
& may notice restricted space

LOOK FOR:
(8)

A

Enlarged tonsils
Enlarged tongue
Elongated uvula
Decreased airway space
When patient says “Ahh”
Elongated soft palate
V shaped palate
Micrognathia/Retrognathia

28
Q

upper airway patency during sleep depends on (2)

A

 Upper airway size & stiffness
 Neuronal control of pharyngeal muscles

29
Q

 If you observe: (1) restricted airway space or
(2) retrognathia, ask patient about (4)
 Refer patient to physician for an evaluation
and polysomnogram sleep study (PSG)- spent
overnight in a sleep laboratory. As a dentist,
you cannot order the sleep study.

A

snoring,
gasping for air, poor sleep quality and
daytime fatigue

30
Q

— will demonstrate size and position of tongue and narrowing of oropharynx

A

MRI

31
Q

polysomnography (PSG)
(3)

A
  1. Is REQUIRED by insurance prior to treatment
    (pre-treatment), M.D. must order PSG
  2. Is REQUIRED at end of completion (post-
    treatment) to determine efficacy of oral
    sleep apnea appliance although some
    insurance will accept the home sleep study
  3. May be ordered while titrating appliance or
    a home sleep study may be authorized
32
Q

polysomnography (PSG)
 Monitors:
(7)

A

 Sleep stages
 Respiration
 Oxygen saturation
 Nasal & oral airflows
 Electrocardiography (EKG)
 Electroencephalography (EEG)
 Sleep position

33
Q

skipped
predictors for favorable response to MAD
Clinical
(6)
Craniofacial
(3)

A

 Younger age
 Lower BMI
 Lower neck
circumference <17”
 Positional OSA
 Lower AHI (not
consistently)
 Increased
protrusion

 Larger oropharynx
 Smaller overjet
 Short soft palate
length

34
Q

contraindications for sleep apnea devices
(4)

A
  1. Insufficient teeth to support device however
    can be made if 1 arch is edentulous
  2. Periodontal problems causing tooth mobility
  3. Active temporomandibular joint disorder
    (TMD) or severe arthritis
  4. Limited maximum protrusion < 6mm
35
Q

–% of drivers admit to falling asleep at wheel

A

20

36
Q

Sleep ranks among the – most important
considerations in maintaining good
health

A

3

37
Q

sleep
 –% of U.S. population
 experiences intermittent or regular sleep
problems
 –% of these adults have NEVER discussed
sleep problems with their physician
 Societal bias equates sleepiness with LAZINESS

A

62
80

38
Q

skipped
Sleep disorder symptoms –%
Insomnia –%
< 7 hours sleep duration –%
Non-restorative sleep –%
Snore nightly/ weekly –%
Daytime fatigue /sleepiness –%
Driving while sleepy –%
-Accidents/near accident –%
Fatigue affects intimacy –%

A

75
33-54
40
38
32
37
60
4
20

39
Q

Apnea Hypopnea Index (AHI): Obstructive Sleep Apnea Rating
0-4 events per hour:
5-15 events per hour:
16-30 events per hour:
>30 events per hour:

A

No OSA
Mild
Moderate
Severe

40
Q

dx of sleep apnea
(5)

A
  1. Spouse or family member reports
    snoring/apnea
  2. Medical History OR Hypertension raises
    suspicion
  3. Dental examination reveals upper airway
    anatomical abnormalities
  4. Degree of sleepiness can be assessed with
    a short questionnaire (i.e. Epworth
    Sleepiness Scale)
  5. If the above raise suspicion for sleep-
    related disorder, physician will refer to a
    sleep laboratory
41
Q

approved tx
(5)

A
  1. CPAP(continuous positive airway pressure)/Bilevel
    positive pressure (BiPAP)- gold standard
  2. ENT surgery – uvulopalatoplasty (UVPP),
    tonsillectomy, deviated septum surgery,
    turbinectomy, genioglossus advancement or
    implanted nerve stimulator
  3. Maxillomandibular advancement surgery
  4. Mandibular advancement devices (MADs)
  5. Inspire neurostimulator that stimulates
    glossopharyngeal nerve to protrude tongue so
    airway space remains open
42
Q

continuous positive airway pressure (CPAP)
(3)

A

 Splints the upper airway pneumatically during
sleep so airway does NOT collapse
 Highly effective but cumbersome
 Long-term compliance is 60 – 70%

43
Q

general tx (5)

A
  1. Altering sleep position (i.e. raise head of
    bed)
  2. Avoidance of alcohol, muscle relaxants &
    sedatives or narcotics
  3. Relieving nasal congestion
  4. Reducing weight
  5. Smoking cessation
44
Q

CPAP intolerance
 Due to:
(6)

A
  1. Claustrophobia
  2. Mask leaks
  3. Mask and tubing are bulky especially when
    changing sleep position
  4. Must remove CPAP mask to use restroom
  5. Contact dermatitis or allergy from mask
  6. Embarrassment
45
Q

uvulopalatropharyngoplasty (UVPP)
(3)

A

 Surgical removal of uvula with resection of
soft palate tissue to create more space
 50% of patients report improved sleep apnea
symptoms but not always long term
 Surgery to correct deviated septum, nasal
polyps, tonsillectomy and chronic rhinitis may
also help

46
Q

skipped
custom sleep apnea appliances are recommended
(7)

A
  1. Numerous designs
  2. Advance the mandible
  3. Better tolerated by patients than CPAP
  4. Better fit than soft appliances- OTC not
    recommended
  5. Can create or exacerbate existing TMD
  6. Can possibly CREATE A MALOCCLUSION
  7. Medical billing for appliance
47
Q

 Mandibular Advancement Devices (MAD):
 Oral Appliance Therapy (OAT)
 Titratable Thermoplastic Devices (TPD)
 Over the Counter Devices-

A

Custom –made by Dentist- fully adjustable

NOT
RECOMMENDED-available directly to the
patient(
non-custom made) MAY NOT BE
TITRATABLE

48
Q

custom appliances (OA)
 OA therapy is most effective for patients with
—
 OA therapy may also be efficacious for
patients with — OSA

A

mild/moderate OSA.
severe

49
Q

Computer-Aided Design and Computer Assisted Manufacturing
(3)

A

 The mandibular advancement device is
custom-made using a computer-aided design
and manufacturing (CAD/CAM) process.
 Use Trios scanner or Impressions/models
upload scans into computer- send the dental
lab
 Design is “milled” on 3-D printer by the dental
laboratory using medical grade nylon or acrylic
*Computer-Aided Design and Computer Assisted Manufacturing
PANTHERA

50
Q

 Only the custom appliances significantly
reduced the AHI
 Failure rate with prefabricated (non-custom)
devices was –%
 –% of patients who failed with the
prefabricated device were successfully treated
with the custom device.
 –% of patients preferred the custom device
 Vanderveken et al. AJRCCM 2008.

A

69
63
82

51
Q

MOA
1. Normally made —% of the maximum
protrusion
2. Widening of the airway —
3. Relocation of the —
laterally
4. — displacement of the tongue base
5. Protrusion is normally accompanied with —

A

50-75
laterally
pharyngeal fat pads
Anterior
increased vertical dimension

52
Q

Selection may be based on the following:
(6)

A
  1. Size of patient arch
  2. Lack of sufficient undercuts (facial height of
    contour) to retain appliance
  3. Number of missing teeth
  4. Size/volume of appliance and size of mouth
    affect comfort
  5. Patient preference
  6. Patient allergy to acrylic or nickel- make
    SomnoMed Avant OR Panthera sleep
    appliance
53
Q

AVANT sleep apnea appliance
(3)

A

 Has nylon advancement rods that patient can
change at home
 Less driving and less appointments needed
 No metal

54
Q

appliance side effects - per patient (7)

A
  1. Too much or too little saliva
  2. Irritation on cheeks or lips by fins or
    rods
  3. Inability to close lips
  4. Jaw pain
  5. Feels like a “mouth full”
  6. Change in occlusion in the morning or
    permanent
  7. Gum pain
55
Q

follow up visits
1. Initially at –weeks & order treatment
sleep study to determine efficacy of sleep
appliance. Every – months for the 1st year,
and annually thereafter
2. Check compliance
3. Patient-induced damages (i.e. Due to
modifications, bruxism)
4. Check oral health, occlusion and TMJ
5. Referral to a sleep physician as necessary

A

2-4
6

56
Q

contraindications for sleep apnea devices
(4)

A
  1. Insufficient teeth to support device but if
    good bone support can be made
  2. Periodontal problems causing tooth mobility
  3. Active temporomandibular joint disorder
    (TMD) or severe arthritis
  4. Limited maximum protrusion < 6mm
57
Q

effectiveness of sleep apnea devices
 METHODS:
 33 consecutively treated patients were
evaluated
 Sleep study done 1 night without device & 1
night with device after 0.7 & 5.2 years from
start of treatment

 RESULTS:
 – of 33 patients experienced short-term
satisfactory results with an apnea-hypopnea
index (AHI)of <10 events/hour and
decreased snoring
 – of 33 patients were insufficiently treated
 – of the 19 short-term satisfactorily treated
patients (90%) continued treatment on a
long-term basis
 a significant reduction (p<0.001) in the
apnea-hypopnea index from 22 to 5
events/hour was demonstrated by individuals
wearing the sleep apnea device

A

19
14
17

58
Q
A

DMOP (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions