Epilepsy There is an association between OSA and epilepsy (Lin, et al., 2017). In a clinical study of 283 adult epilepsy patients, coexistence of OSA with epilepsy was found in 10.2% of patients. The major risk factors for OSA were the same as those typically found in the general population. Of the epilepsy- related factors, older age at onset of seizures appeared to be significantly related to comorbidity with OSA (Dougherty and Johnson, 2018). Metabolic syndrome Metabolic syndrome is a group of metabolic disturbances that predict an increased risk for Type 2 diabetes mellitus and cardiovascular diseases. The variables that constitute the criteria for metabolic syndrome are abdominal obesity, high triglyceride levels, low levels of high-density lipoproteins, high blood Patients suffering from sleep apnea are at twice the risk for motor vehicle accidents caused by drowsiness (Espiritu, 2019). The National Highway Traffic Safety Administration estimated that drowsy driving was responsible for 800 fatalities and 44,000 nonfatal injuries in the United States in 2013; however, according to the CDC, these numbers probably represented a drastic underestimate (CDC, 2017a). Furthermore, 4.7% of the participants in the 2009 BRFSS survey reported nodding off or falling asleep while driving in the preceding 30 days. Patients suffering from sleep apnea contribute greatly to this staggering statistic (CDC, 2011). Cognitive decline Social sequelae Increase in motor vehicle accidents Obstructive Sleep Apnea is correlated with the development and advancement of cognitive decline (Walia, 2019). Evidence exists that attention and memory are adversely affected by OSA, as are other aspects of executive functioning. In a meta- analysis, patients with OSA demonstrated medium to very large impairments in all domains of executive function (which, in addition to attention and working memory, include the ability to inhibit impulses, control emotional reactions, and
pressure, and high fasting glucose (American Heart Association, 2016). Studies have shown that OSA is an independent risk factor which can double or triple the risk of the development of metabolic syndrome (Qian, et al., 2016). Psychiatric disorders One year after a diagnosis of OSA the incidence of depression per 1,000 persons was 18% compared to 8% of individuals without OSA (Walia, 2019). Many patients who are diagnosed with OSA also exhibit the signs of clinical depression. A study by Lee, et al., of 793 patients who were diagnosed with a mild form of OSA revealed that 46.2% of these patients reported symptoms of depression (Lee, et al., 2016). A review of the literature reveals an association between OSA and depression but the precise interrelationship is not known (Harward and Speer, 2019). plan and organize). With CPAP treatment, cognitive function demonstrated small to medium improvements (Walia, 2019). Occupational health impairment Untreated OSA can have adverse effects upon an individual's personal and professional life. Interrupted sleep patterns typical of OSA challenge the ability to stay awake during working hours and can decrease the attention span which is necessary to complete work-related tasks. (Rudolph, et al., 2018). Mood swings which can occur because of OSA can cause adverse effects upon personal and employment-related relationships the combination of which can distract an OSA patient from their work (Rudolph, et al., 2018). All-cause mortality “All-cause mortality” refers to all of the deaths occurring in a population, regardless of the cause. Pan and colleagues (2016) conducted a meta- analysis of prospective cohort studies to clarify the association between obstructive sleep apnea and future risk of all-cause mortality. Twelve prospective cohort studies involving 34,382 patients were included in this meta- analysis. Results indicated that severe (but not mild to moderate) OSA is significantly associated with increased risk of all-cause mortality.
SCREENING AND DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA
with a sleep history that could be obtained as part of a routine health maintenance evaluation. The dental professional can incorporate the Epworth Sleepiness Scale (ESS) or similar screening items into an existing health questionnaire (American Dental Association, 2021). Positive responses to these screening questions should alert the dental professional to the possibility of a sleep breathing disorder. In 2017, the AASM published updated guidelines concerning the diagnosis and testing of adults for OSA, strongly recommending that a diagnosis not be made in the absence of polysomnography or home testing (Kapur et al., 2017).
Given the clinical consequences of untreated OSA, it is important that dental professionals recognize the clinical presentations of OSA and screen for the condition in clinical practice. A practicing dental professional who works in a collaborative fashion with primary care physicians and sleep specialists can have an important in treating a patient with OSA (American Dental Association, 2021). Clinical guidelines and evidence- based recommendations that provided guidance for screening, diagnosis, and management of OSA in adults have been updated by the AASM (Patil, et al., 2019). The AASM guidelines stressed that the diagnosis of OSA started
Orofacial characteristics of the obstructive sleep apnea patient Certain orofacial findings may indicate an increased risk of OSA (American Dental Association, 2021; Poss, 2016)). These findings include: ● An enlarged tongue with scalloped lateral borders that obstructs the oropharyngeal space. ● The “Friedman tongue position,” which obstructs the clinician’s view of the uvula or oropharynx (Friedman, et. al., 2017). ● A long, sloping soft palate. ● A high palatal vault. ● An enlarged, swollen, or elongated uvula. ● Enlarged tonsils and / or adenoids.
● Unfavorable Mallampati score. ● Nasal obstruction / allergic rhinitis. ● Narrowing in regions of the upper airway.
The Mallampati Scoring System (MSS) was developed as a classification system of the oropharyngeal opening and is used as a screening tool to identify patients with potentially difficult intubations and is based on the visibility of airway structures (e.g., tonsils, pillars, soft palate, uvula) with the mouth open and tongue protruded (Mouri, et al., 2021). Although the MSS is frequently mentioned in the sleep apnea literature, there is controversy regarding its predictive value in OSA. Among children with OSA one study found a strong link between the (MSS) and AHI and tonsil size while studies among adult patients with OSA have yielded conflicting results between the relationship between the (MSS) and the occurrence of OSA (Chanine and Wright, 2021).
● Mandibular retrognathia. ● A narrow mandibular arch. ● Alar rim collapse during forced inspiration. ● Forward head posture.
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