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Sleep Apnea

Oral appliance therapy (OAT) is a recognized treatment for snoring and other forms of sleep-disordered breathing (SDB), upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA). It is recommended that orthodontists who treat any type of SDB should do so in conjunction with the patient’s physician.

While snoring by itself is often the presenting complaint, in a significant percentage of sufferers it is the principal symptom of a more serious condition, obstructive sleep apnea (OSA), which ranges from mild to moderate to severe. OSA left untreated may predispose a patient to cardiovascular complications such as heart attacks and strokes as well as gastro-esophageal reflux disease. OSA may also give rise to daytime drowsiness, leading to an increased risk of work- related and motor vehicle accidents and fatalities. It is therefore important that orthodontists treating snoring ensure that any treatment not only eliminates snoring but also any related OSA, if this condition is shown to exist. This can best be accomplished through the use of a polysomnogram (PSG) both in the diagnostic stage, as well as afterwards to confirm treatment success.

Definitions

Apnea: Cessation of airflow for 10 seconds or longer.
Sa02: Blood oxygen level (given as a percentage).
Hypopnea: Decrease in airflow by 50 percent or more for 10 seconds or longer and associated with a decrease in Sa02 by more than four percent and /or arousal.
Respiratory index (RDI): the total number of apneas and hyponeas per hour.
Mild OSA: generally an RDI of 10-20, although some clinicians accept slightly different numbers.
Moderate OSA: RDI of 20-40.
Severe OSA: RDI greater than 40.
CPAP: continuous positive airway pressure

Dr. Milne uses an oral appliance to control sleep apnea.


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