Orthodontics and Sleep Apnea

What is sleep apnea?

Sleep apnea is a serious disorder where you repeatedly stop breathing for periods during sleep. There are two main forms: central sleep apnea, where the brain is not properly controlling breathing, and obstructive sleep apnea, where the airway is temporarily closed off  or restricted due to relaxed soft tissues in the throat. Sleep apnea results in insufficient oxygen in the blood. It can result in excessive daytime sleepiness, morning headaches, irritability, and delayed mental development and attention issues in children. It is associated with increased risk for auto accidents, heart attacks, and stroke. Partners may notice loud snoring, periods of not breathing during sleep, and/or gasping for air during sleep.  This post will focus on obstructive sleep apnea, as there has been much recent attention on orthodontics and sleep apnea of this type.

Who is at risk for obstructive sleep apnea?

Anyone can suffer from sleep apnea, but those who are at particular risk are males, folks over 50, those who are overweight–with a BMI of over 34, and those with a neck measurement of 17 inches for males and 16 inches for females. Children with enlarged tonsils and adenoids are at risk as well. Keep in mind that obstructive sleep apnea is can result from multiple factors, such as airway size, the degree to which the muscles around and the throat relax, nervous system issues, and elasticity of the soft tissue.

What about orthodontics and sleep apnea?

There are many popular theories about how orthodontics and sleep apnea are related. These include how orthodontics can cause, prevent, or cure obstructive sleep apnea. Some believe that extract of teeth reduces space for the tongue and thus can predispose individuals to obstructive sleep apnea. Research shows no such relationship. Our teeth are arranged in each jaw in the shape of a U, referred to as “arches”. It is thought that expansion of the arches can cure or prevent airway issues. Research has shown that in children with upper jaw constriction, expanding the arch can reduce nasal pharyngeal resistance and the number of incidents of apnea events. Research also shows that certain children with mild apnea can get worse with expansion of both arches. It is also important to know that there are risks of damaging the supporting bone and gums with even minor expansion of the arches, so it should not be done as a matter of routine. A physician should evaluate any child suspected of suffering from sleep apnea BEFORE any orthodontic treatment is initiated for the purpose of addressing it. Another way  in which orthodontics and sleep apnea are considered is in adults who are treated with surgical advancement of the upper and lower jaws. Typically those patients will have orthodontic treatment in preparation for the surgery, and their bites are refined with braces following the surgery.

What should you know about orthodontics and sleep apnea?

  1. Only physicians can diagnose sleep apnea. It’s important that any dentist or orthodontist involved in sleep apnea treatment do so in conjunction with a sleep physician. Dentist cannot interpret take-home sleep tests. A main role for dentists is to screen for those at risk of sleep apnea and then refer to a sleep physician.
  2. CPAP positive air pressure devices (pictured below) are still considered the gold standard for sleep apnea treatment, but compliance is low because patients have to wear a mask or nasal device for air delivery. If you have orthodontic and or surgical treatment for airway or apnea reasons, a sleep physician should reassess you following the treatment.
    CPAP air pressure device

    Resmed CPAP

     

  3. Your treating doctor should inform you of both the risks and potential benefits of any proposed treatment.
  4. If your or your child’s physician doesn’t seem to take your airway concerns seriously, consider consulting with a sleep physician.
  5. Be wary of anyone who seems to prescribe the same treatment for everyone, of dentists/orthodontists who diagnose sleep apnea, or of dentists/orthodontists who treat sleep apnea without the input of a physician.

Thank you for reading this blog post. If you have any questions, feel free to contact my office.

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