Sleep apnea syndrome is becoming more and more frequent in dental practices. The reasons are, according to experts in dentistry and stomatology, a better identification of the same and therefore an increase of cases with positive diagnosis and, on the other hand, certain habits that our current society entails that contribute to its appearance and enhance its symptomatology.
What is sleep apnea and what does it consist of?
Sleep apnea is the interruption of breathing during sleep, causing different types of snoring (snoring), with a pattern of frequency and duration of episodes that will determine the severity of the process. In this sense, and in general, we can classify sleep apnea in three degrees:
– Mild: when the frequency is between 5 and 15 apneas per hour and the duration of each does not exceed 10 seconds.
– Moderate: when the frequency is between 15 and 30 apneas per hour and the duration of each may exceed 10 seconds.
– Severe or severe: when the frequency exceeds 30 apneas per hour and the duration of each apnea may exceed 10 seconds.
What causes sleep apnea
The cause of sleep apnea falls into two main groups:
– Obstructive sleep apnea: comprises the majority of cases and is caused by any process or circumstance that produces or favors an obstruction of the airway. Among other causes would be: large tonsils and vegetations, very small lower jaw, obesity, alterations in the shape of the palate, large tongue that falls backwards, sleeping on the back.
– Central sleep apnea: occurs in very few cases and is caused, roughly speaking, by any process or circumstance that prevents proper communication between the brain and the respiratory muscles. In this group would be: heart failure, stroke, exposure to high altitudes, taking certain drugs.
Who is more predisposed to sleep apnea?
As for the incidence and predisposing factors we must say that it is slightly more common in men than in women, above 40 years. In higher age ranges, 60 to 80 years, the incidence increases considerably. In these cases, overweight is an important predisposing factor, as well as tobacco and alcohol consumption and large meals before bedtime. It is also frequent in children, occurring in most cases due to the presence of hypertrophic tonsils and large vegetations that partially obstruct the airways. It can also occur in infants, in these cases produced by choanal atresia, i.e., a decrease in the anatomical space that serves as a passage between the posterior part of the nostrils and the pharynx, thus causing a difficulty in the passage of air.
Symptoms of sleep apnea
Among the symptoms that accompany patients with sleep apnea is snoring as the main manifestation. In most cases it is usually what causes the patient to consult a specialist. It is usually a loud snore interrupted abruptly by a final snort, although it can take other forms (different types of snoring). We also find morning headache, sustained tiredness and fatigue, daytime sleepiness (microsleeps), alterations in concentration and memory, erectile dysfunction and depression.
What is the diagnosis of sleep apnea?
The diagnosis is quite simple in most cases, based on the explanations given by the patient about his symptoms. It is completed with blood tests and, mainly in the most severe cases, with a polysomnographic study in a sleep unit where they will accurately confirm and evaluate the degree of severity of the apnea. For this, the patient must spend the night in the unit, recording while sleeping the heart rate, blood oxygen saturation (oximetry), and performing an electrocardiogram (ECG) and an electroencephalogram (EEG).
The risks of sleep apnea
The prognosis of sleep apnea, regardless of its cause, is related to an increased risk of cardiovascular disease and whether or not adequate treatment is instituted. Without it, severe apneas (more than 30 in 1 hour) can reach a mortality rate of up to almost half of sufferers over a 10-year period.
Treatment of sleep apnea
In most cases, the treatment of sleep apnea is usually palliative, relieving the symptoms, although it will depend on the cause and its severity.
In all cases, the establishment of healthy habits is of vital importance. We are talking about controlling weight, avoiding tobacco and alcohol consumption, exercising, sleeping on the side and regulating the periods of sleep and wakefulness, guaranteeing adequate sleep hours.
In cases of mild and moderate apneas, the use of mandibular advancement devices can be very effective. These consist of an intraoral splint that is placed over the teeth, forcing the jaw into a more forward position, preventing blockage of the airways, improving oxygenation and, therefore, the quality of sleep. They also help to eliminate snoring, which is one of the effects most valued by patients. These devices are custom-made and personalized for each patient.
In moderately complex and severe cases, the CPAP respiratory mask is usually used, which consists of a mask that is placed over the nose and mouth connected to a device that produces a positive air pressure that penetrates the airways keeping them open during sleep, thus avoiding pauses in breathing. It requires a period of learning and getting used to its use.
Finally, in highly indicated cases or when previous more conservative treatments have not worked, certain surgical techniques can be performed to try to improve apneas. These include removal of very large tonsils, removal of nasal polyps, correction of the nasal septum and palate reshaping techniques. It is usually rare to resort to these surgical techniques given the good results obtained with conservative treatments, and the risks and complications inherent to them.