Snoring and sleep apnea
Snoring (snoring) is a condition that afflicts about one in four Italians and interferes with the quality of one's sleep and, indirectly, with that of partners and family members.
Normally snoring is the noise that results from the vibration of the organs involved in breathing:
the soft palate;
the uvula;
the larynx;
the tongue.
A high percentage of snorers are affected by obstructive sleep apnea syndrome (OSAS), which is pauses in breathing during sleep.
Sleep apnea is due toairway obstruction, caused by anatomical and inflammatory conditions, resulting in narrowing of the air space that restricts or blocks the passage of air.
Sleep alterations can impair the overall health status, even causing serious damage:
poor quality of sleep at night;
severe reduction in body oxygenation;
increased cardiac activity (tachycardia), which, in the long run, can lead to cardiovascular decompensation;
daytime sleepiness;
significant decrease in attention;
altered relationship with food and consequent obesity;
diabetes;
heart attack, hypertension and heart disease.
Recent studies have found that OSAS sufferers have a shorter life expectancy of 5 to 10 years.
Snoring can also affect infants as young as a few months of age. White crib deaths may be an effect of OSAS.
Snoring and apnea
Airway obstructions during sleep.
Health risks
Sleep alteration.
Heart attack.
Hypertension.
Heart disease.
Diabetes.
Obesity.
Decline in attention.
Relationship difficulties.
How to diagnose
Mandibular advancement devices (MAD).
Dental treatment
Mandibular advancement devices (MAD).
CPAP mask.
Diagnosis of snoring and apnea snoring
With the use of Polysomnography, snoring-related diseases can be diagnosed. During night sleep, parameters of:
respiratory flow;
oxygenation level;
snoring levels;
quality and quantity of sleep;
position during sleep;
number, frequency and duration of apneas.
The watch pat is an innovative digital instrument that allows the examination to be performed at home, instead of traveling to a hospital facility.
It is worn before bedtime, following easy instructions provided by the study.
During the night, the device records data that are downloaded the next day and are then used for diagnosis.
The watch pat can also be used for diagnosis in children.
What are the dental solutions?
Once the presence of upper airway pathology (e.g., nasal septum deviation, tonsils, adenoids, presence of polyps) is ruled out post specialist examination, mandibular advancement devices (MAD) are applied, an effective solution for resolving snoring and mild-medium sleep apnea and valuable support for more severe forms.
CPAP, a mask for oxygenation and nocturnal ventilation, is applied in the most severe cases, in collaboration with the pulmonologist, when the oxygen level is too low (AHI and ODI above 35/40).
How MAD works
It is a device similar to a splint. It is inserted on both arches, moving the jaw forward, creating more space in the throat and thus promoting the passage of air.
The insertion is absolutely painless.
It is worn overnight and removed in the morning.
What to do to snore less: helpful tips
Keep weight under control: weight gain leads to thickening of the neck and narrowing of the airway;
change sleeping position;
avoid alcohol and sedative intake;
avoid smoking;
getting up and going to bed at regular times;
practice regular physical activity.
The stages of the pathway
Visit and data collection
The visit begins with the completion of the "stop bang test": an entry test to check for possible symptoms, such as: daytime sleepiness, non-restorative sleep, fatigue, insomnia, nocturia. The numerical result indicates the percentage of risk. The clinical examination is concerned with anatomy: shape of the palate (mallampati), size of the tongue, shape and size of the uvula, size of the jaw, reduced size of the nostrils, recessed chin, dry or excessively wet lips (a sign of oral respiration), and any inflammatory states (tonsils, adenoids, etc.). If the first visit shows medium to high risk states, the watch pat is given to perform Polysomnography and check the parameters of the key indices.
1
The treatment/care plan
When the data are within the average range, a treatment of choice, that is, the best possible therapy to treat the disorder (application of MAD), can be implemented. A follow-up visit is scheduled every 2 months to check that the mandibular advancement is correct, that the MAD is not compressing tissue, and that no other changes are taking place. Approximately 6 to 8 months after application, Polysomnography is repeated to check for improvement in indices. If the data exceed the average, other specialists, particularly ENT, pulmonologist, and dietician, should be consulted to determine the correct course of action. The application of MAD becomes adjunctive to other therapies.
3
Evaluation
Polysomnography is an important instrumental test to highlight the three basic indices, symptoms of snoring-related diseases:
AHI: measures the average apnea/hour during sleep;
ODI: measures oxygen desaturation, i.e., how often you fall below the minimum mean;
REM: measures the quality of sleep.
Based on the results, a diagnosis is made and possible priorities set, also in collaboration with other specialists. Snoring is a clinical condition that is often reversible and improvable through targeted solutions and lifestyle changes.
2
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