Snoring and Apnea

F.A.Q.

About Snoring and Sleep Apnea

Sleep Dentistry allows the dentist to act in the treatment of disorders related to breathing problems during sleep, such as snoring and obstructive sleep apnea (OSAHS).

Sleep apnea and hypopnea syndrome (OSAHS) is a chronic, progressive, disabling respiratory disorder with high morbidity and mortality, characterized by partial (hypopnea) or total (apnea) obstruction of the upper airways. Its appearance is associated with genetic and environmental factors and can worsen with the use of alcohol, drugs, sedentary lifestyle, aging, mouth breathing, obesity, tonsil and adenoid hypertrophy, dorsal decubitus, retrognathism, macroglossia and others. Epidemiological studies have suggested that 2 to 4% of the population suffer from this syndrome and that its prevalence is increasing due to the obesity epidemic. The male population has a higher prevalence with 9% between 30 and 60 years of age and women represent 4%.

Individuals with OSAHS have compromised quality and life expectancy. Among the signs and symptoms, snoring is the main clinical marker; excessive daytime sleepiness, non-restorative sleep; changes in cognitive functions in which they have attention, memory and concentration deficits; changes in neuroendocrine and cardiovascular functions; night urine; morning headache; changes in mood and physical fatigue.

Protocol and Treatments

Diagnosis is based on clinical history, physical and radiographic examination. After clinical evaluation, it is necessary to carry out a specific quantitative examination, polysomnography (PSG), which consists of monitoring physiological parameters during sleep in order to diagnose the severity; the type of apnea; muscle changes (sleep bruxism); cardiac; respiratory and brain.

The therapeutic measures to be taken will depend on the severity of the disorder diagnosed, ranging from:

Sleep Hygiene – Behavioral measures
CPAP (Continuous Positive Airway Pressure = Continuous Positive Airway Pressure) – Gold Standard
Intraoral Appliances (OAs)
Surgeries
Combined therapies

Intraoral appliances are indicated for the treatment of mild and moderate OSAHS, being considered the first choice for these disorders since 1995 when the American Sleep Disorders Association (now the American Academy of Sleep Medicine) recognized them as an effective alternative to CPAP therapy. OAs are easy to adapt, portable and inexpensive. The main objective is to promote the increase of the upper airways through mandibular advancement. It is important to clarify that in cases of severe OSAHS, these devices can be used, provided that other therapeutic modalities have been contraindicated or refused. In these cases, we must consider that the intraoral devices represent part of the treatment, which is multidisciplinary and, therefore, require long-term follow-up, in addition to the patient’s cooperation with regard to the behavioral aspects mentioned above.

NEW TECHNOLOGY: LITETOUCH DENTAL LASER

The Litetouch laser, Er: YAG modality, is one of the most recent technologies for the treatment of snoring, being a low-cost option when compared to other treatment alternatives. The tip used in the procedure has a design that reaches areas with little space quickly and efficiently. It increases the tonus of the soft palate and in this way decreases its vibration in the passage of air. Less snoring!

How it Works

The laser light preheats the tissue of the entire soft palate region, including the tonsils, tonsillar pillars and uvula, and stimulates the formation and contraction of collagen fibers, strengthening the tissues and reducing the intensity of snoring or even stopping it altogether.

Agile Protocol

The protocol consists of 6 sessions lasting 15 minutes each. It is a safe procedure, does not require anesthesia, is comfortable and allows the patient to continue his daily routine as normal.

Lasting Result

Studies indicate that the results of using the Er:YAG laser can last up to a year. Annual periodic reviews after discharge are important.

Frequently asked questions about sleep apnea and snoring

How are Intraoral Appliance adjustments made?

The device allows the mandibular advancement to be made in a subtle and gradual way. The correct change in mandibular position, in successive advances, promotes better results and maximum comfort, and may also solve joint and muscle discomfort. In cases of primary snoring, the device is advanced until the patient or his/her partner informs that the snoring has been controlled. Consultations for OA monitoring should be performed every fortnight, as this is the average time for the patient to adapt to the device. The advances, if necessary, are quantified in approximately 1mm at each visit.

Does everyone who snores have OSAHS?

Snoring is just a symptom of the condition, so not everyone who snores has sleep apnea. The diagnosis is always made through Polysomnography (PSG), which is sleep monitoring by electronic equipment. Clinical examination is indicated to assess the condition of the patient’s respiratory tract and should be performed by a physician with specialization in the area.

How is the severity of obstructive sleep apnea and hypopnea syndrome (OSAHS) assessed?

OSAHS is considered mild when drowsiness or involuntary sleep episodes occur during activities that require little attention (watching television, reading or riding in a car as a passenger). At this degree of disease, the symptoms produce a slight change in social and occupational function. On polysomnography, the apnea-hypopnea index (AHI) is greater than 05 and less than or equal to 15. In the case of moderate OSAHS, drowsiness or sleep episodes occur during activities that require some attention (cinema, theater). They produce moderate changes in social and occupational function. The AHI is greater than 15 and less than or equal to 30. In severe OSAHS, drowsiness or involuntary sleep episodes occur during activities that require greater concentration (talking, eating, walking, driving). They cause serious changes in social and occupational function. The AHI is greater than 30.

Remember that the Intraoral Appliance will be more effective in cases of mild and moderate OSAHS.

Is there a relationship between OSAHS and TMD?

There is still a great need for studies that point to this direct correlation between the two pathologies. There are articles that claim that among patients diagnosed with TMD of muscular origin, Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) is the second most frequent sleep disorder, second only to insomnia. It is known that headache when waking up and non-restorative sleep are common complaints in patients with Muscular TMD, and also in patients with OSAHS. The most indicated professional for the effective treatment with Intraoral Appliances is the specialist in TMD and Orofacial Pain, as he is able to identify and treat the signs and symptoms of TMD that may be simultaneous with the treatment of OSAHS.

Our Experts

Bachelor’s Degree in Dentistry, UnB
Specialist in TMD and Orofacial Pain, IEO – Bauru
Specialist in Oral Rehabilitation, Instituto ARIA – DF
Laser therapist, ARIA Institute – DF
Founding member of the Brazilian Society of TMD and Orofacial Pain (SBDOF)
Excellence Course in Composite Resins, Newton Fahl – Curitiba
Improvement Course in Botulinum Toxin and Orofacial Fillers, ABO – GO
Visiting Professor at the University of Brasília, Prosthesis Area of Clínica Integrada II – 2017
PACTO Method Coordinator, Centro Odontologia Integrada Simone Carrara