By Azita Anissi, DDS, DABDSM O bstructive sleep apnea (OSA) remains an important clini-cal and public health chal-lenge. Overall, OSA is a multifactorial disease that affects nearly 1 billion individuals globally and affects 34% of men and 17% of women in the United States. 1,2 Included among the many risk factors for OSA are obesity, a geneti-cally small airway, facial structure abnormalities, and enlarged tongue size. Consequently, OSA is associated with an increased risk for atheroscle-rotic cardiovascular disease, hyper-tension, Type 2 diabetes, as well as all-cause mortality. 3 However, the diagnosis and treat-ment for OSA remain elusive, as approximately 75% of severe cases of OSA of individuals remain undi-agnosed and/or undertreated, 4 caus-ing a significant burden to the patient and broader healthcare systems in the setting of chronic disease management. Trained dental assessment in the treatment of OSA holds promise for helping to address such challenges by provid-ing an additional means for the primary care assessment of OSA and by offering complimentary treat-ment options and modalities, including retainer-based therapies. This review focuses on the clini-cal presentation of OSA from young children to adults, and the general treatment algorithm for each disease subtype. We will then discuss the emerging field of Dental Sleep Medicine in treatment of OSA, which may be used in synergy with the cornerstone of care, continuous positive airway pressure (CPAP). This will follow with a section on how general dentists and pediatrics dentists can have a major impact in recognizing and treating patients with OSA in their clinical practice. Through this process, we hope to further underline the value of dentists in the assessment and management of OSA to help reduce the chronic disease burden in the general population. neurochemistry. 5 Additionally, sleep facilitates hormonal regulation, memory consolidation and other neurocognitive functions. There are several sleep regulatory factors such as biological time of the day, also known as the circadian clock, homeostatic drive, and other vari-ables such as the environment, age, social behavior and genetics. 6 These factors all collectively have an impact on our sleep. Children in general need between 9-11 hours of sleep per night, whereas adults require 7-9 hours of sleep per night. 6 Disruptions of the sleep cycle will negatively impact both daily function and overall health. Overview and Mechanism of OSA Overall, OSA is a common disor-der, characterized by repetitive upper airway collapse during sleep. 7 In particular, OSA consists of episodes of complete closure of upper airway (apnea) or partial closure (hypopnea) during sleep. As a result, hypoxemia and hypercap-nia develops, which further stimu-Sleep Species require sleep in order to conserve energy, regulate brain temperature, and modulate of 30 Summer 2021 JAOS
Journal of the American Orthodontic Society Summer 2021: Page 30
