Of the general adult population in middle age, 93% of women and 82% of men with moderate to severe sleep apnea syndrome have not been clinically diagnosed. Sleep apnea is even less likely to be diagnosed in the older population. Unrecognized sleep-disordered breathing is linked to motor vehicle accident occurrence in the general population and may account for a significant proportion of motor vehicle accidents. Dentistry can play an important role in the recognition and treatment of this disease continuum in cooperation with your physician(s).

Normal Breathing

When you breathe normally, air passes through the nose and past the flexible structures in the back of the throat such as the soft palate, uvula and tongue. While you are awake, muscles hold the airway open. When you fall asleep, these muscles relax but, normally, the airway stays open.

Snoring

Snoring is the sound of obstructed breathing during sleep. While snoring can be harmless(benign snoring), it can also be the sign of a more serious medical condition which progresses from upper airway resistance syndrome (UARS) to obstructive sleep apnea. (OSA)

Snoring, a common malady that affects persons of all ages but especially middle-aged men and elderly men and women who are overweight , has been identified as a risk factor for high blood pressure, heart attacks and and stroke. Although not all people who snore have obstructive sleep apnea, snoring is a cardinal symptom of obstructive sleep apnea and, thus, may be associated with increased morbidity and mortality. Furthermore, snoring in some patients without apnea has been associated with significant sleep disturbance and excessive sleepiness. This condition has been referred to as upper airway resistance syndrome and is characterized by repeated nocturnal arousals without recognizable hypopneas or apneas.

Snoring occurs when the structures in the throat are large and when the muscles relax enough to cause the airway to narrow and partially obstruct the flow of air. As air tries to passes through these obstructions, the throat structures vibrate causing the sound we know as snoring. Large tonsils, a long soft palate and uvula and excess fat deposits contribute to soft tissue narrowing.

Obstructive Sleep Apnea

When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and air flow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears and the flow of air starts again, usually with a loud gasp. People with obstructive sleep apnea (OSA) have disrupted sleep, and low blood oxygen levels. OSA has been associated with cardiovascular problems and excessive daytime sleepiness. The condition known as upper airway resistance syndrome (UARS) lies midway between benign snoring and true obstructive sleep apnea. People with UARS suffer many of the symptoms of OSA but normal sleep testing will be negative.

working with your physician

Because snoring is so common, both the medical profession and the public have regarded it as merely an annoyance to one's bedpartner or as a source of humor. With the realization that an oral appliance could stop snoring, the natural assumption by the dental profession was, therefore, that treatment of snoring could be incorporated into the dental practice simply and easily. Snoring is, in actuality, one stage of a complex continuum of disease states culminating in obstructive sleep apnea. Understanding the complicated pathophysiology of obstructive sleep apnea is essential to proper treatment and underscores the necessity of dentist-physician interaction.

The consequences of undiagnosed and incompletely treated sleep apnea are medical in nature and are disease states with which most dentists are unprepared to cope. In addition to an increased rate of motor vehicle accidents among the sleep apneic population , systemic hypertension has been reported in up to 50% of patients with sleep apnea. In fact, mean morning blood pressure has been shown to increase almost linearly with an increasing severity of obstructive sleep apnea in both obese and non-obese patients. Understanding this, Dr. Barsh has attended special courses and have consulted with sleep physicians in order to more completely understand our role as members of the treatment team.

This office is pleased to participate in the treatment of a potentially life-endangering disease and we cooperate with colleagues in the medical community as part of your treatment team. We work closely with your physician(s) in order to secure the best possible outcome for you.

epworth test

The only way to be sure if you have obstructive sleep apnea is to have a sleep test either at home from a qualified sleep physician or in a hospital sleep center. But a score of 9 or above on this test is an indication that you should see your doctor.

Please feel free to print this test, fill it out and take with you to your physician.

The Epworth Test

How likely are you to doze off or fall asleep in the following situations?

Choose the most appropriate number for each situation:

• 0 = would never doze
• 1 = slight chance of dozing
• 2 = moderate chance of dozing
• 3 = high chance of dozing

A score of 9 or above indicates you may be having a problem with daytime sleepiness but below 9 does not necessarily mean that you don't have a problem. See your healthcare professional for advice if you snore, have been told that you awake gasping for breath or if you are sleepy during the day.