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NEUROLOGY &
SLEEP DISORDERS

Obstructive Sleep Apnea:

An Overview

By Major (Dr.) Nicholas Scalzitti

bstructive sleep apnea (OSA) is one of the most to stabilize the upper airway and maintain patency for airflow.
O common sleep disorders diagnosed in our society. Currently, an increasing number of providers are prescribing au-

Some authors have estimated that as many as 1 in 5
tomatic positive airway pressure (APAP) machines which work
adult patients are afflicted by this disorder. OSA is a through the same mechanism. However, these machines can au-
condition of recurring collapse of the upper airway during sleep tomatically adjust or titrate pressure within the prescribed range
that leads to sleep disruption and repeated episodes of hypoxia as needed to prevent apneas and hypopneas. As the machines are
and sympathetic nervous system surges. Patients with OSA and capable of recognizing these events, they can provide a compli-
their bed partners often report symptoms of snoring, restless sleep, ance report that offers information regarding the amount of de-
witnessed apneas, gasping/choking arousals from sleep, excessive vice usage and its effectiveness (residual AHI).
daytime sleepiness, drowsy driving episodes, and poor memory and The most important factor limiting the effectiveness of posi-
cognitive function. The nocturnal symptoms not only disturb the tive airway pressure is compliance with therapy. Studies have sug-
patient’s sleep, but also the sleep of the bed partner. gested that as many as 50 percent of patients do not tolerate or
The importance of recognizing and diagnosing this disorder is continue using PAP therapy in the long-term. Due to this, alter-
highlighted by its ability to degrade sleep quality and cause day- native treatment options are necessary. For milder cases of OSA,
time sleepiness, as well as negatively impact other systemic ill- changes in sleep positioning, such as sleeping on the side or with
nesses such as hypertension, arrhythmias, cardiovascular and the head elevated, can be helpful. For patients that are overweight
cerebrovascular disease, and diabetes mellitus. Given these serious or obese, weight loss can be an adjunctive treatment which both
consequences of untreated OSA, as well as the high prevalence lowers the AHI and results in subjective improvement in sleep
of disease, medical providers should routinely screen at risk pop- quality. Dental devices
ulations. Simple validated questionnaires (e.g. STOP-BANG) exist called mandibular advance-
to easily stratify patients who warrant a sleep study. Sleep studies, ment devices (also called
or polysomnography, can be performed either in a sleep labora- oral appliances) are effec-
tory or at home to identify the presence of OSA. The diagnosis tive in treating both snoring
of OSA is made based on the number of apneas (complete ces- and mild to moderate OSA.
sation of airflow) and hypopneas (partial decreases in airflow) These appliances can be ob-
per hour of sleep, termed the apnea-hypopnea index (AHI). tained on an over-the-
After the diagnosis is made, treatment should be initiated for counter basis, but
MANDIBULAR ADVANCEMENT
any patient with moderate or severe OSA, or any patient with custom-fitted and ad- DEVICE (ORAL APPLIANCE)
mild OSA who exhibits bothersome symptoms. For over 3 justable devices made by dental professionals are generally more
decades, the gold standard of treatment for OSA has been con- effective. As the name suggests, these devices have their effect
tinuous positive airway pressure (CPAP) therapy. These machines by bringing the lower jaw (mandible) to a more anterior position
provide positive pressure through nasal or oral-nasal interfaces during sleep, which slightly moves the tongue and possibly the

26 San Antonio Medicine • August 2018