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Learn More About Snoring and Sleep Apnea and Sleep Dentistry

QUICK LINKS: Click on the link to jump to the topic	Prevalence	Quality of Life	Medical Complications
	In Children	In Pregnancy	Motor Vehicle and Work-Related Injuries
	In Seniors	In Pre-Surgical Patients	Self-Test

Prevalence

• Roughly 1 out of 5 adults has at least mild OSA (obstructive sleep apnea)
• 2- to 3-fold greater risk for men than women
• Pregnancy may be a period of particular risk for OSA in women
• OSA is highly prevalent in people older than 65 years
• OSA is the most common chronic disease in industrialized societies
• With the obesity problem in the United States, the problem is getting worse
• For more information, review Epidemiology of Obstructive Sleep Apnea at
  http://arjccm.atsjournals.org/cgi/content/full/165/9/1217

Quality of Life

• Second-Hand Snoring:

Anyone who has slept with a person who snores knows that it can disrupt his or her sleep. Many bed partners of snorers suffer from the same daytime sleepiness problem that their snoring partner does. Snoring also can affect marriages adversely more commonly than many people think. Early results from a study being conducted at the Sleep Disorders Center at Rush University Medical Center show that there is a significant impact on the bed partner's quality and quantity of sleep and that this does lead to a hostile and tense situation within the marriage.

Health-Related Quality of Life:

(See also Medical Complications of Sleep Apnea)

"...undiagnosed OSA affects quality-of-life on a par with other chronic disorders of moderate severity."[1]

Motor Vehicle and Work-Related Accidents

"...patients with OSA syndrome have high motor vehicle crash rates, based on crash records as well self-report and poor performance on driving simulators. Because traffic safety is under governmental regulation, there are legal implications for both private and commercial drivers if OSA is a significant cause of impaired driving." [1]

In Children

Witnessed apneas occur in approximately 5% of children. Although obesity is a less important risk factor in children than adults, symptoms of sleep-disordered breathing occur 2 to 3 times more often than they do in non-obese children. A minimum prevalence of OSA of 2% to 3% is likely, with a prevalence as high as 10% to 20% in children who snore habitually. Daytime sleepiness is reported in 1/4 to 1/3 of children. [1] Also see Children's Sleep Problems and ADHD


According to the American Sleep Apnea Association (http://www.sleepapena.org/resources/pubs/child.html) children may present with hyperactivity, inattentiveness, aggressive behavior, irritability, and mood swings. "OSA in children is a serious disorder that, untreated, may result in health problems as well as behavior and academic problems."

• Down Syndrome
  It is important that the dental health provider be aware of the incidence of sleep apnea in the Down Syndrome population. It has been reported that the incidence of upper airway obstruction may be as high as 31% in children with Down Syndrome. The decreased airway size combined with lowered muscle tone predisposes these patients to obstructive sleep apnea.
  
  Left untreated, obstructive sleep apnea can further increase developmental delay and contribute to pulmonary hypotension and congestive heart failure. Symptoms of OSA include snoring, restless sleep and unusual sleeping positions. If a patient's family or caregiver reports these symptoms, then referral to a sleep disorders clinic is indicated.
  
  Treatment may include occusal repositioning appliances, positive airway pressure, and/or surgical correction. Adenotonsillectomy in children with Down Syndrome and sleep apnea has been helpful in some cases. [2]
  
  
• ADHD --------- Also see Children's Sleep Problems and ADHD
  In a study by Chervin in the March 15, 2002, issue of Sleep found that youngsters who snore or have sleep disorders are almost twice as likely to suffer from ADHD than those who sleep well.
  
  Inattention and hyperactivity among general pediatric patients are associated with increased daytime sleepiness — Especially in young boys — snoring and other symptoms of Sleep Disordered Breathing (SDB); if sleepiness and SDB do influence daytime behavior, the current results suggest a major public health impact.
  
  
• Pediatric OSA Surgery
  According to some scientific reports, the airway is smaller in children with OSA as compared with children who do not have OSA. The adenoidal and tonsillar tissues are larger. The soft palate is larger as well. In addition, in many children with OSA dental-facial abnormalities, the treatment of OSA may not end with Tonsillectomy and adenoidectomy and children may require orthodontic treatment.[3]
  
  
• Orthodontics and OSA
  The use of orthodontics as both a treatment for and prevention of OSA is a complex subject and new in the scientific literature. In almost every case, bicuspids should NOT be removed by the orthodontist to make room in a crowded dentition, but rather the arch should be expanded.
  
  For further information read Sleep and Breathing (2005), Vol. 9, pp. 146-158, by Makoto Kikuchi entitled, "Orthodontic treatment in children to present sleep-disordered breathing in adulthood."
  

In Pregnancy

Women are 2 to 3 times more likely to snore during pregnancy. According to a research team at the University of Edinburgh, in Scotland the airway of pregnant women narrows in the last trimester of pregnancy. They found that if a woman has severe snoring or sleep apnea, the health of both the mother and fetus can suffer. In pregnant women, blood pressure rises as airways become narrower. Data indicate that pregnant snorers have an increased risk of pre-eclampsia.

This is also a problem for the woman's partner and may cause tension within the couple at the very time when she most needs support.

Snoring is common in pregnancy, and snoring pregnant women have increased rates of pre-eclampsia. Patients with pre-clampsia showed upper airway narrowing during sleep. The study demonstrated that women with pre-eclampsia have upper airway narrowing in both upright and lying postures. These changes could contribute to upper airway resistance episodes during sleep in patients with pre-clampsia, which may further increase their blood pressure. [5]

Sleep disturbances are frequent during pregnancy. The association between pregnancy and sleep disturbances ranges from an increased incidence of insomnia, nocturnal awakenings, and parasomnias (especially restless leg syndrome), to snoring and excessive sleepiness. These disturbances occur as a result of physiologic, hormonal, and physical changes associated with pregnancy. Although the timing and occurrence of different sleep disorders varies, they are most prevalent in the third trimester. [6]

Many changes in the respiratory system occur during pregnancy, particularly the third trimester, which can alter respiratory function during sleep, increasing the incidence and severity of sleep-disordered breathing. These changes include increased ventilatory drive and metabolic rate, reduced functional residual capacity and residual volume, increased alveolar-arterial oxygen gradients, and changes in upper airway patency. The clinical importance of these changes is indicated by the increased incidence of snoring during pregnancy, which is likely to also reflect an increased incidence of obstructive sleep apnea/hypopnea syndrome. For the physician asked to review a pregnant patient, the possibility of sleep disordered breathing should always be considered. [7]

In Seniors

Several studies have found that OSA is prevalent in people older than 65 years. Additional studies found that those 65 to 100 years of age had a prevalence of OSA that was approximately twice as high as middle-age. [1]

In Pre-Surgical Patients

Sleep apnea patients are at higher risk of peri-operative and cardiac adverse events. The risk of such adverse events can be reduced if the condition is recognized in the pre-operative period. [4]

Learn more about treatment options

The above information is courtesy of http://www.quietsleep.com

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