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Sleep Apnea Management for the Dentist

Course Number: 578

OSA Consequences and Pathophysiology

Unfortunately the consequences of OSA go beyond just a feeling of tiredness and the annoyance of snoring. One well-studied consequence of OSA, which is also related to aging and obesity, is cardiovascular disease (CVD). CVD may manifest as hypertension, atrial fibrillation or other arrhythmias, cerebrovascular events (stroke), transient ischemic attacks, coronary artery disease (CAD), pulmonary hypertension and even heart failure.

The hypoxia associated with OSA stimulates carotid chemoreceptors resulting in activation of the sympathetic nervous system with downstream elevations in blood pressure. Furthermore, hypoxia is followed by re-oxygenation and the development of reactive oxidative species that can lead to endothelial lesion formation inside the lumen of blood vessels leading to thrombotic lesion formation in CAD. The risk of atrial fibrillation is 5% in OSA while 1% in controls without OSA. Also, OSA leads to glucose intolerance and decreases insulin release and this may lead to the development of diabetes.9 The OSA patient may also report diminished cognitive skills if the condition is not well managed. Also of note to men, as OSA is higher amongst them, serum testosterone is lower in OSA men.10

In more tangible every-day terms, drowsy driving can be as risky as alcohol impaired driving. The undiagnosed, under treated, or non-treated OSA driver presents risks when driving trucks or automobiles. Motor vehicle accidents (MVAs) attributed to drowsy driving are a common occurrence. They pose a risk of injury or death to the drivers themselves, other passengers, pedestrians, or passengers from other vehicles. Injuries and damages related to MVAs have financial and legal consequences. This information sometimes provides the extra impetus to patients who are hesitant to pursue OSA diagnostic work-ups or management.

To further illustrate the point, in 2016 the train crash at the Hoboken New Jersey train terminal was, at least in part believed to be a result of the engineer on board suffering from untreated OSA.

Fortunately, OSA is a modifiable risk factor of CVD. Treating OSA with positive airway pressure (PAP) decreases systolic BP by 2.8 mmHg. PAP is the first course of therapy in managing these health risks and mandibular advancement devices can be used in those patients who cannot tolerate PAP or have less severe forms of OSA.