Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 48

Presentation Summary

Doctors

Sleep Apnea: Screening and Treatment
Options for Children and Adults
Dr. Mahshid Mehdipour

Presented by Dr. Rose Sheats at the PCSO Annual
Session, October 13, 2017
Dr. Sheats noted that it is important for orthodontists to know that they have an important
role in managing sleep-disordered breathing
(SDB). The AAO will discuss the role of orthodontists in managing SDB at its 2018 conference.
Dr. Sheats mentioned that the term SDB is a
more deliberate term than obstructive sleep
apnea (OSA). SDB consists of snoring, hypopnea,
and OSA; it is the most common sleep disorder
after insomnia.

Dr. Rose Sheats
Orthodontics and
Dentofacial Orthopedics,
Chapel Hill, NC

Classic risk factors for OSA in adults have been
males, age, obesity, and alcohol consumption.
Recent data shows that one in every five American adults has OSA with variable phenotypes;
80% to 90% of Americans with OSA remain undiagnosed; 6% have moderate or severe cases; and
75% of severe OSA cases are undiagnosed, with
similar prevalence all over the world. SDB can be
diagnosed by physicians via an overnight lab
sleep study test, home sleep apnea test (HSAT/
HST), and clinical exam.
Dr. Sheats defined an apnea event as complete
cessation of breathing (90% of airflow) for a
duration of at least 10 seconds or two breaths.
Hypopnea is defined as a decrease of about
30% of airflow for the duration of two breaths
or 10 seconds. In breathing studies, it is important
to understand the metric value of the apneahypopnea index (AHI) to measure the severity
of SDB and the number of respiratory events
per hour. The normal AHI for adults is less than
5 episodes per hour; mild is 5 to 15; moderate is
15 to 30; and severe is 30 or more episodes per
hour. In previous studies, where hypopnea was
not measured, if the apnea events occurred more
than 20 times per hour there was a 40% chance
of mortality within 10 years. The risks of untreated
SDB are very similar to cardiovascular conditions;
they include sudden death, stroke, hypertension,
coronary artery disease, atrial fibrillation, conges-

48

tive heart failure, type 2 diabetes, and depression.
Public health burdens of SDB are bed partner
impact, occupational or vehicle accidents, health
cost, and decreased quality of life for families,
spouses, and colleagues.
Several studies revealed that the survival rate for
normal to moderate untreated SDB is more than
85%, in comparison with severe cases, where the
rate is only about 55%. Dr. Sheats mentioned that
the all-cause mortality rate was about three
times greater in severe SDB compared to normal
SDB cases, but cardiovascular mortality was five
times greater in the severe cases than in normal
cases. The signs and symptoms of witnessed
apneas include snoring, gasping, and choking
during sleep, excessive sleepiness, maintenance
insomnia, gastro-esophageal reflux disease
(GERD), morning headaches (due to excess CO2),
and decreased libido.
Use Patient Questionnaires
Dr. Sheats encouraged orthodontists to provide
patient questionnaires at the initial appointment
in order to diagnose those with SDB. There are
two kinds of screening tests: the Epworth Sleepiness Scale (ESS), which assesses daytime sleepiness, and the STOP-BANG test, which assesses
the risk of SDB. She noted that the clinical symptoms include obesity, hypertension, retrognathic
mandible, large tongue with scalloped borders,
bruxism, GERD, crowded posterior airway (Mallampati airway classification), and enlarged tonsils or uvula.
Dr. Sheats described different treatment modalities, including continuous positive airway pressure (CPAP), rapid maxillary expansion (RME), and
mandibular advancement devices (MAD). She
mentioned that CPAP could cause the teeth to
move because the mouthpiece exerts pressure
on the subnasale area, which coincides with the
apices of the upper incisors. Studies show that
CPAP can cause significant craniofacial changes,
such as retrusion of the upper jaw, setback of

PCSO Bulletin  Winter 2017



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