THE DANGERS OF OBSTRUCTIVE SLEEP APNEA

1. WHAT IS SLEEP APNEA?

Obstructive sleep apnea (OSA) is a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The “apnea” (without breath) in sleep apnea refers to a breathing pause that lasts at least ten seconds… and often more. These pauses can last one minute. OSA occurs when there is a blockage of the upper airway and when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe.

Imagine holding your breath for 10 to 60 seconds… and doing that repeatedly through the night. How much oxygen is passing to your brain, and thus to your other organs?

The combination of disturbed sleep and oxygen starvation may lead to devastating systemic damage. The list of medical conditions associated with OSA is extensive.

OSA can cause loss of life, or at minimum, will severely diminish quality of life. It affects the organs and is connected to strokes, high blood pressure, tachycardia, atrial fibrilosis, diabetes, dementia, weight gain and demeanor of people who have this disease. Daytime sleepiness and inability to concentrate are common symptoms of adults and children. Studies show that OSA is a dominant factor in motor vehicle accidents.

 

This depiction shows a normal and a blocked airway. Notice the large tongue on the right obstructing the air passage to the pharynx.
 

2. THE RISK FACTORS AND HOW THEY CONTRIBUTE TO SLEEP APNEA

  • Excess weight. Fat deposits around your upper airway may obstruct your breathing. However, not everyone who has sleep apnea is overweight. Thin people develop OSA, too.
  • Neck circumference. People with a thicker neck may have a narrower airway.
  • A narrowed airway. You may have inherited a naturally narrow throat. Or, your tonsils or adenoids may become enlarged, which can block your airway. An enlarged or inflamed uvula will block the airway.
  • Being male. Men are twice as likely to have sleep apnea. However, women increase their risk if they’re overweight, and their risk also appears to rise after menopause.
  • Age. Sleep apnea occurs significantly more often in adults over 60.
  • Family history. If you have family members with sleep apnea, you may be at increased risk.
  • Race. In people under 35 years old, blacks are more likely to have obstructive sleep apnea.
  • Use of alcohol, sedatives or tranquilizers. These substances relax the muscles in your throat.
  • Smoking. Smokers are three times more likely to have obstructive sleep apnea than are people who’ve never smoked. Smoking may increase the amount of inflammation and fluid retention in the upper airway. This risk likely drops after you quit smoking.
  • Nasal congestion. If you have difficulty breathing through your nose — whether it’s from an anatomical problem or allergies — you’re more likely to develop obstructive sleep apnea.

3. THE GREAT THING ABOUT SNORING

“What’s the big deal about snoring?”
Who can sleep with the sounds of a freight train 2 feet away from your ear?
Spouses of snorers often have to move into separate bed rooms.

Snoring is disturbing and is a major cause of spousal alienation.

It is a disruption, an annoyance, even a marriage buster, but It is more than that. It is a sign, a signal, an alarm of a very serious airway problem.
Snoring is an attention-demanding WARNING SIGN of sleep dysfunction.
Snoring, like pain, should sound an alert to us that there is something more serious to look for under the surface.

We continue to learn about more illnesses connected to Sleep Apnea:

Cancer

Researchers suggested a correlation between sleep apnea and increased cancer risk of any kind.
Ref: 2010 American Cancer Society

Other serious ailments known to be tied to Sleep Apnea:

Strokes
Dementia
Depression
Heart Disease
Diabetes Mellitus
High Blood Pressure
Chronic Daytime Fatigue
Motor Vehicle Accidents

With an assortment of health threats like these, all Sleep Apnea related, we need to show more respect to snoring.

4. HOW YOU CAN IDENTIFY THE OSA SIGNS IN YOURSELF

  1. Mallampati Classification – A simple self-diagnosing test of your airway
  2. Scalloped Tongue
  3. Abfractions

A patient asks,

Doctor, I always thought these notches are from brushing too hard. They are painful and I have them on my teeth on both sides. What causes them?

Abfractions are common in patients with Obstructive Sleep Apnea. Nocturnal bruxism (teeth grinding while asleep) plays a major role. The effective solution requires treatment of the causes.

An abfraction occurs on the base of the crown of a tooth, near the gum line as shown in the picture below.

The enamel covering the crown tapers down to its thinnest there. When the occlusion (bite) is not balanced, there will be uneven pressures on the biting surfaces of teeth. Those pressures cause a torque on the tooth which produces a slight bend at the center where the crown meets the root. As the tooth keeps bending, the thin enamel at the bottom of the crown, near the gum line, chips away. The sensitive “dentin” surface inside the enamel is now exposed. Vigorous, improper teeth brushing will then wear away the unprotected dentin and the notches will grow deeper and larger.

The dentin also becomes vulnerable to acid erosion from foods such as citrus.

The uneven bite pressures also cause a loss of gum and bone attachment around the roots so the roots become progressively exposed adding to the acute sensitivity to touch and cold. Advanced effects can be fracture of the tooth at the crown-root junction, tooth mobility and serious gum disease.

Abfractions can resemble other conditions like decay or toothbrush abrasion, but the treatment is more specific. The treatment, after diagnosing the cause as a bite dysfunction, consists of balancing the bite to equally and properly distribute the pressures and then to restore the lost tooth structure. An occlusal guard may be required. About 25% of the population clench or grind their teeth at night (Nocturnal bruxism) and are completely unaware of it!.Obviously, the earlier this condition is discovered, the less damage to the teeth and bone will have occurred. In advanced cases crowns may need to be placed to protect the weakened teeth. There is a convincing connection to Obstructive Sleep Apnea. There are some cases where orthodontic treatment may be necessary.

Abfractions are non-carious cervical lesions (NCCL) caused by flexural forces, usually from cyclic loading; the enamel, especially at the cementoenamel junction (CEJ), undergoes this pattern of destruction by separating the enamel rods. Studies show that within the same patient, teeth with abfractions presented more gingival attachment loss than those without abfractions.

Abfractions are common in patients with Obstructive Sleep Apnea. Nocturnal bruxism plays a major role. The effective solution requires treatment of the causes.

If you see these signs in your (or your spouse’s) mouth you may call us for a complementary OSA consultation and screening.