A brilliant summary of orthodontics and Obstructive Sleep Apnea
Obstructive Sleep Apnea is a serious disorder. The role of orthodontists in its treatment was the theme of the recent AAO Winter meeting. This post is a great summary by Dr Greg Jorgensen who attended the meeting.
Dr Jorgensen is an orthodontic specialist who has been in the private practice of orthodontics since his graduation from the orthodontic department at the University of Iowa in 1991. He has been certified by the American Board of Orthodontics and active in organised dentistry. Jorgensen currently serves on the AAO’s Council on Communication. However, he wrote this summary on his own merely as a service to those who were not in attendance at this historic meeting.
The AAO Conference On Obstructive Sleep Apnea And Orthodontics
In light of all of the information (and misinformation) that has appeared in the dental community in recent years, the AAO commissioned a task force in 2017 to examine obstructive sleep apnea and the role that orthodontists play (or don’t play) in the prevention, diagnosis, and treatment of this serious medical condition.
The task force gathered together experts from the fields of sleep medicine, otolaryngology, pulmonology, pediatric medicine, neurology, oral surgery, dentistry, and orthodontics to look at this issue from every possible angle.
After two years of work, this group of unbiased experts drafted a 20-page “white paper” (that will be published as an upcoming AJODO article). This report was the framework for this 18-hour program.
Don’t Kill The Messenger
In this post, I will summarise the information they presented at the meeting on January 25th, 26th, and 27thof 2019. I write merely as a note taker of the presentations and not as an expert on obstructive sleep apnea nor as a representative of the AAO. I hope you find the information as valuable as I did. Because I am not an expert on OSA, I will not debate those who take issue my interpretation.
My only goal is to share this timely information with those who did not attend.
Interest In OSA Sold Out The Conference
Interest in this topic was so great that every seat in the auditorium was filled. All 1,000 delegates stayed fully engaged from the minute the lectures began at 8:00 AM on Friday until the last questions were answered after at noon on Sunday. The attendance was a testament both to the interest in and importance of the topic of obstructive sleep apnea to our profession.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea (OSA) is a severe and life-threatening disease. There is no doubt that it deserves the attention of healthcare providers from every branch of medicine touched by its wide-reaching effects. It is not a new condition, but changing population demographics and discussions within and outside of our speciality have forced it to the forefront in recent years.
OSA is a multi-factorial disease that is not caused by any single factor. Neither is it cured by a single approach in every patient. Importantly, OSA is more than a simple anatomical condition that can be prevented, induced, or treated by changing the shape, size, or position of the dentofacial complex. Instead, it is a complex interaction of neurological, muscular, and physical variables that results in the collapse of the oropharynx (upper airway).
Furthermore, this collapse is caused by a decrease in the tonicity of muscles of the upper airway and not merely a reduction in the size of its lumen. Because it is not just a size issue, procedures that increase the size of the “pipe” (both orthodontic and non-orthodontic) will not cure the disease.
A realistic review of the most current data leads to the conclusion that orthodontists cannot predict, prevent, diagnose, or correct OSA.
Why Is Obstructive Sleep Apnea Important?
OSA in adults causes daytime sleepiness, cognitive impairment, vehicular accidents, and relationship strain. It also causes nighttime snoring with intermittent pauses, restlessness, and frequent trips to the bathroom.
Finally, it can also result in hypertension, strokes, decreased life expectancy, and even death.
Children exhibit daytime issues of behavioural problems (ADHD), learning disabilities, and inattention. At night they present noisy, laboured breathing, restlessness, mouth breathing, unusual body positions, and bed wetting. OSA can also cause failure to thrive as well as a host of other heart and circulation issues in affected young people.
What is the prevalence of Obstructive Sleep Apnea?
Recent studies suggest that the prevalence of OSA is 1-4% in children of healthy weight. But those numbers climb to over 50% in children who are obese. 10% of the men and 3% of the women between the ages of 30 and 50 have OSA. Those numbers rise to 17% in men, and 9% in women over the age of 50 as their overall muscular tonicity decreases. The prevalence of OSA in obese men and women rises to over 75%.
What Are The Causes Of Obstructive Sleep Apnea?
There are many causes of OSA. We can summarise these as;
- Decreased or altered neuromuscular tone in the upper airway,
- increased volumes of soft tissue around the airway (obesity),
- old age (general loss of muscle tonicity throughout the body),
- neuromuscular conditions,
- the presence of abnormal adjacent structures that narrow the airway (like enlarged tonsils, adenoids, pharyngeal pillars, and the uvula).
There is no evidence that the following cause OSA;
- the position of the teeth,
- the width of the arches,
- the size of the nasal cavity,
- the length of the lingual frenum
When we look at any influence of orthodontic treatment. There is no evidence linking orthodontic procedures (headgear, extractions, or so-called “backwards pulling mechanics,” etc.) to the development of OSA.
Additionally, there has been “no direct causal relationship between craniofacial structure and pediatric SDB”. OSA is not merely an anatomical disease.
What Are The Risk Factors For Obstructive Sleep Apnea?
Decreased muscle tonicity of the upper airway which allows its collapse is the cause of OSA. Importantly, anything that causes, reduces, or contributes to that condition can be a factor. It is clear that obesity is the #1 risk factor as decreased muscle tonicity in combination with a reduction in the lumen of the airway due to fat deposits makes obturation much more likely. Other factors are ageing, injury, neuromuscular disorders, being male, having a larger neck circumference, smoking, and genetics.
In children, tonsil and adenoid hypertrophy is an essential factor. It is important to note that there has been no direct causal relationship identified between craniofacial structure and pediatric SDB (i.e., arch constriction, dental extractions, headgear therapy, or retraction of the anterior teeth).
I will post the second part of this blog post next week.