Practice profile Continued »
(enlarged tonsils, micrognathia – a lower jaw smaller than normal), neck flexion and nasal obstruction. Mechanical factors are supine posture,
increased upper airways resistance and increased upper airway compliance. Upper airway muscle function – abnormal upper airways muscle activity; impaired relationship of upper airways muscle and diaphragm contraction. Upper airway reflexes – impaired
response to negative pressure and feedback from the lungs. Central factors are reduced chemical
drives, increased periodicity of central drive and inadequate response to breath loading. Finally, under the heading of arousal,
we have impaired arousal responses and post-apnoeac hyperventilation.
The consequences Sleep-related breathing disorders (SRBDs) have an adverse effect on the cardiovascular, metabolic, endocrine, nervous and immune systems and the metabolic cycle. There have been numerous studies
on the relationship between SRBDs and cardiovascular consequences. Originally the coexistence of SRBDs with cardiovascular diseases was thought to be due to shared risk factors such as age, gender and obesity. However, Bananian et al published an article ‘Cardiovascular consequences of sleep-related breathing disorders’, in which they stated: “... recent epidemiologic data confirm an independent association between SRBDs and the different manifestations of cardiovascular diseases.” (http://
europepmc.org/abstract/med/ı2350242). Kathleen A Ferguson and John A Fleetham published an article in Thorax in ı995 which went into great detail about the consequences of sleep disordered breathing (
http://www.ncbi.nlm.nih.gov/ pmc/articles/PMCı02ı3ı9/). In relation to cardiac consequences, they
cited systemic hypertension, stating: “In patients with sleep disordered breathing, there are brief phasic changes in blood pressure superimposed on a cyclical pattern which coincide with the upper airways obstruction.” For pulmonary hypertension/right heart
failure, they wrote: “The cyclical changes in pulmonary artery pressure parallel the changes in systemic blood pressure.” They also considered cardiac function –
“Treatment of sleep disordered breathing can improve cardiac function in selected patients” – ischaemic heart disease
(coronary artery disease) and cardiac arrhythmia (irregular heartbeat). The Wisconsin Sleep Cohort (WASC)
is an ongoing longitudinal study of the causes, consequences and natural history of sleep disorders, particularly sleep apnoea, which has been running for more than 20 years. Research into coronary heart disease as part of WASC, published in SLEEP, the joint publication of the Sleep Research Society and the American Academy of Sleep Medicine, concluded: “Participants with untreated severe sleep disordered breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep disordered breathing. Our findings support the postulated adverse effects of sleep disordered breathing on coronary heart disease and heart failure.” (see
www.journalsleep.org/ViewAbstract. aspx?pid=29996).
“Snoring and obstructive sleep apnoea are serious conditions with possible grave consequences”
AHI stands for apnoea-hypopnoea index
– the average apnoeas and hypopnoeas that occur during sleep. Mild OSA is in the AHI scale of five to ı5. Moderate OSA is when AHI is between ı5 to 30. Severe OSA, with an AHI of 30 or more, could, for example, mean falling asleep while driving. The metabolic syndrome, including
cardiovascular disease, diabetes and stroke, is diagnosed when an individual presents with three or more of the following factors:
ı. Increased waistline with high BMI 2. Increased blood cholesterol HDL 3. Increased blood triglycerides 4. Increased blood pressure 5. Impaired fasting glucose.
Other consequences of SRBDs include
cerebrovascular disease, excessive daytime sleepiness, personality and behavioural changes, decreased libido and/or impotence and nocturia (the need to urinate during the night). For clarity and convenience, I list these consequences of SRBDs below:
ı. Daytime fatigue with an increased risk of road traffic and work-related accidents
2. Decreased cognitive function 3. Increased risk of cardiovascular disease
4. Increased risk of diabetes 5. Eye complications 6. Memory loss 7. Learning difficulty and growth in children
8. Sleep-deprived partners with ensuing marital strife
9. Complications during sedation and general anaesthetic for surgery
ı0. Morning headaches ıı. Mood swings and depression ı2. Nocturia ı3. Decreased libido and erectile dysfunction
ı4. Depression ı5. Insomnia.
Conclusion Snoring and obstructive sleep apnoea are serious conditions with possible grave consequences, including an increased mortality rate. Dentists can work alongside the medical profession to help with the screening, assessment and subsequent treatment process. The British Society of Dental Sleep
Medicine (BSDSM), of which I am president, is a professional organisation for members of the dental team interested in helping patients seeking help for snoring and obstructive sleep apnoea. It advocates medical diagnosis and the provision of the most appropriate therapy. The BSDSM runs one-day introduction
to dental sleep medicine courses and more information, as well as online booking, is at
www.dentalsleepmed.org.uk
ABOUT THE AUTHOR
Dr Aditi Desai graduated as a dentist from University of Wales, Cardiff in 1977. President of the British Society of Dental Sleep Medicine, she serves on the odontological council and sleep medicine council at the Royal Society of Medicine. Aditi is founder of Global Sleep Solutions, a company set up to bring about a multidisciplinary approach to the management of sleep disorders. Aditi is a restorative dentist with special interest in sleep medicine and part of a multidisciplinary dental specialty team in London’s Harley Street. Working in Harley Street, Portsmouth and London Bridge Hospital as part of the Sleep Service, she maintains a multidisciplinary team approach in her management of patients with sleep disordered breathing. Aditi lectures in the UK and abroad on the subject of dental sleep medicine and is accredited by the European Academy of Dental Sleep Medicine (EADSM).
Ireland’s Dental magazine 43
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