Obstructive sleep apnea (OSA) is a respiratory pathology characterized by the presence of total (apneas) or partial (hypopneas) upper airway obstructive episodes, which condition the appearance during sleep of intermittent hypoxia, micro awakenings and increased negativity of intrathoracic pressure during inspiration.
It is studied and diagnosed by means of polysomnography, a diagnostic test in which a series of parameters are measured during sleep.
What are its symptoms?
The symptoms that may appear in OSA are:
- Excessive daytime sleepiness.
- Unrefreshing sleep with excessive fatigue
- Snoring
- Nocturnal breathing pauses
- Asphyxitic awakenings
- Daytime headache
- Lack of concentration
- Decreased libido
- Depression
- Deterioration of quality of life
- Increased incidence of occupational and traffic accidents.
- Increased cardiovascular risk (hypertension, arrhythmias, stroke, heart disease…).
- Insulin resistance
- Diabetes
- Obesity
Can it be prevented?
Fundamentally, we can act by correcting overweight. Obesity must be treated by taking hygienic-dietary measures to improve our quality of sleep: sleeping on your side, not sleeping less than 6 hours a day, regular physical exercise, avoiding large meals before going to sleep, giving up smoking and alcohol, and avoiding as far as possible the use of sedatives.
What treatment should a patient suffering from sleep apnea follow?
The most common treatment for OSA, and especially for severe or very severe OSA, is the use of a CPAP (continuous positive airway pressure) device during the night. Basically, it is an air compressor that produces a positive and constant pressure, which allows keeping the airway open, avoiding respiratory pauses during sleep and helping rest. Sometimes, this CPAP is not tolerated by the patient, which leads to a high percentage of treatment abandonment.
For this reason, there is currently a tendency to treat mild and moderate OSA without cardiovascular repercussions, and in general, all those patients with intolerance to CPAP, with an intraoral device that the patient wears during sleep and that our dentist or oral and maxillofacial surgeon is in charge of indicating. These are mandibular advancement devices (MADs), which are devices that hold the mandible in a forward position so that it advances the base of the tongue, opening the airway and allowing air to pass through.
MADs are also the treatment for chronic rhoncopathy. Current DAMs are customized, taking into account the patient’s morphology and jaw movements, making them safe devices for the temporomandibular joint. There are other surgical treatments for OSA and performed by the oral and maxillofacial surgeon, such as maxillomandibular advancement and other surgical techniques with very good long-term stable results.
How are the results of the treatment?
The DAM is a device with high tolerance and patient compliance, up to 96%, with very good results with respect to AHI (apnea-hypopnea index), with reductions of more than 50% of AHI in most cases in patients with mild or moderate OSA and success rates of more than 90% in the treatment of chronic rhoncopathy. The results of maxillomandibular advancement surgeries can cure the OSA patient, becoming a definitive treatment without having to use DAM or CPAP again.