OJST  Vol.5 No.7 , July 2015
Obstructive Sleep Apnea, Prevalence, Etiology & Role of Dentist & Oral Appliances in Treatment: Review Article
Objective: The aim of this article is to provide a detailed description for obstructive sleep apnea regarding its signs and symptoms, the way it is diagnosed, the risk factors, management, the role of dentists and oral appliances in treatment and consequences of untreated condition. Material and Method: Electronic searching was done in PubMed, Medline, EMBASE and CENTRAL databases. Inclusion criteria were: dental, oral and maxillofacial oriented articles. Exclusion criteria: cardiac, obesity and non dental oriented articles were excluded. Result: 59 articles meet the criteria. Conclusion: Obstructive sleep apnea (OSA) is a potentially life threatening disorder characterized by repeated collapse of the upper airway during sleep, with periodic cessation of breathing for more than ten seconds. The frequency of obstructive sleep apnea has been found to increase with age; ranging from two percent among children to two and half percent - six percent among adolescents. Overnight polysomnographic test at specialized sleep clinics remains the gold standard for diagnosing obstructive sleep apnea disorder. Management of this condition can be performed via surgical and non surgical methods. Continuous positive airway pressure represents the first line of treatment for most patients with obstructive sleep apnea.

Cite this paper
Jaradat, M. and Rahhal, A. (2015) Obstructive Sleep Apnea, Prevalence, Etiology & Role of Dentist & Oral Appliances in Treatment: Review Article. Open Journal of Stomatology, 5, 187-201. doi: 10.4236/ojst.2015.57024.
[1]   Johal, A., Battagel, J.M. and Kotecha, B.T. (2005) Sleep Nasendoscopy: A Diagnostic Tool for Predicting Treatment Success with Mandibular Advancement Splints in Obstructive Sleep Apnea. European Journal of Orthodontics, 27, 607-614.

[2]   Capua, M., Ahmadi, N. and Shapiro, C. (2009) Overview of Obstructive Sleep Apnea in Children: Exploring the Role of Dentists in Diagnosis and Treatment. Journal of the Canadian Dental Association, 75, 285-289.

[3]   Wildhaber, J.H. and Moeller, A. (2007) Sleep and Respiration in Children: Time to Wake up! Swiss Medical Weekly, 137, 689-694.

[4]   Rosen, C.L., Larkin, E.K., Kirchner, H.L., Emancipator, J.L., Bivins, S.F., Surovec, S.A., et al. (2003) Prevalence and Risk Factors for Sleep-Disordered Breathing in 8- to 11-Year-Old Children: Association with Race and Prematurity. Journal of Pediatric, 142, 383-389.

[5]   Johnson, E.O. and Roth, T. (2006) An Epidemiologic Study of Sleep-Disordered Breathing Symptoms among Adolescents. Sleep, 29, 1135-1142.

[6]   Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S. and Badr, S. (1993) The Occurrence of Sleep Disordered Breathing among Middle Aged Adults. The New England Journal of Medicine, 328, 1230-1235.

[7]   Stradling, J.R. and Crosby, J.H. (1991) Predictors and Prevalence of Obstructive Sleep Apnea and Snoring in 1001 Middle Aged Men. Thorax, 46, 85-90.

[8]   Bondemark, L. and Lindman, R. (2000) Craniomandibular Status and Function in Patients with Habitual Snoring and Obstructive Sleep Apnea after Nocturnal Treatment with a Mandibular Advancement Splint: A 2-Year Follow-Up. European Journal of Orthodontics, 22, 53-60.

[9]   Ye, L., Pien, G.W. and Weaver, T.E. (2009) Gender Differences in the Clinical Manifestation of Obstructive Sleep Apnea. SleepMed, 10, 1075-1084.

[10]   Duran, J., Esnaola, S., Rubio, R. and Iztueta, A. (2001) Obstructive Sleep Apnea-Hypopnea and Related Clinical Features in a Population-Based Sample of Subjects Aged 30 - 70 yr. American Journal of Respiratory and Critical Care Medicine, 163, 685-689.

[11]   Battagel, J.M., Johal, A. and Kotecha, B. (2000) A Cephalometric Comparison of Patients with Snoring and Obstructive Sleep Apnea. European Journal of Orthodontics, 22, 353-365.

[12]   Ryan, C.M. and Bradley, T.D. (2005) Pathogenesis of Obstructive Sleep Apnea. Journal of Applied Physiology, 99, 2440-2450.

[13]   Flemons, W.W., Buysse, D., Redline, S., et al. (1999) Sleep-Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research—The Report of an American Academy of Sleep Medicine Task Force. Sleep, 22, 667-689.

[14]   Magliocca, K.R. and Helman, J.I. (2005) Obstructive Sleep Apnea: Diagnosis, Medical Management and Dental Implications. Journal of the American Dental Association, 136, 1121-1129.

[15]   Qian, W., Tang, J., Jiang, G. and Zhao, L. (2015) Pharyngeal Wall Floppiness: A Novel Technique to Detect Upper Airway Collapsibility in Patients with OSAS. Otolaryngology—Head and Neck Surgery, 152, 759-764.

[16]   Weaver, J.M. (2014) Increased Anesthetic Risk for Patients with Obesity and Obstructive Sleep Apnea. Anesthesia Progress, 51, 75.

[17]   Malhotra, A. and White, D.P. (2002) Obstructive Sleep Apnoea. The Lancet, 360, 237-245.

[18]   Peppard, P.E., Young, T., Palta, M., Dempsey, J. and Skatrud, J. (2000) Longitudinal Study of Moderate Weight Change and Sleep-Disordered Breathing. The Journal of American Medical Association, 284, 3015-3021.

[19]   Tangugsorn, V., Skatvedt, O., Krogstad, O. and Lyberg, T. (1995) Obstructive Sleep Apnoea: A Cephalometric Study. Part I. Cervico-Craniofacial Skeletal Morphology. European Journal of Orthodontics, 17, 45-56.

[20]   Enache, A.M., Nimigean, V.R., Mihaltan, F., Didilescu, A.C., Munteanu, I. and Nimigean, V. (2010) Assessment of Sagittal and Vertical Skeletal Patterns in Romanian Patients with Obstructive Sleep Apnea. Romanian Journal of Morphology and Embryology, 51, 505-508.

[21]   Dotan, Y., Pillar, G., Schwartz, A.R. and Oliven, A. (1985) Asynchrony of Lingual Muscle Recruitment during Sleep in Obstructive Sleep Apnea. Journal of Applied Physiology, 118, 1516-1524.

[22]   Guilleminault, C., Connolly, S.J. and Winkle, R.A. (1983) Cardiac Arrhythmia and Conduction Disturbances during Sleep in 400 Patients with Sleep Apnea Syndrome. American Journal of Cardiology, 52, 490-494.

[23]   Morgan, B.J., Dempsey, J.A., Pegelow, D.F., Jacques, A., Finn, L., Palta, M., et al. (1998) Blood Pressure Perturbations Caused by Subclinical Sleep-Disordered Breathing. Sleep, 21, 737-746.

[24]   McCrillisa, J.M., Haskell, J.A., Haskell, B.S., Brammer, M., Chenin, D., Scarfe, W.C. and Farman, A.G. (2009) Obstructive Sleep Apnea and the Use of Cone Beam Computed Tomography in Airway Imaging: A Review. Seminars in Orthodontics, 5, 63-69.

[25]   Ciccone, M.M., Scicchitano, P., Zito, A., Cortese, F., Boninfante, B., Falcone, V.A., Quaranta, V.N., Ventura, V.A., Zucano, A., Di Serio, F., Damiani, M.F. and Resta, O. (2014) Correlation between Inflammatory Markers of Atherosclerosis and Carotid Intima-Media Thickness in Obstructive Sleep Apnea. Molecules, 19, 1651-1662.

[26]   Chan, J., Edman, J.C. and Koltai, P.J. (2004) Obstructive Sleep Apnea in Children. American Family Physician, 69, 1147-1154.

[27]   Beebe, D.W. (2006) Neurobehavioral Morbidity Associated with Disordered Breathing during Sleep in Children: A Comprehensive Review. Sleep, 29, 1115-1134.

[28]   Gottlieb, D.J., Vezina, R.M., Chase, C., Lesko, S.M., Heeren, T.C., Weese-Mayer, D.E., et al. (2004) Symptoms of Sleep-Disordered Breathing in 5-Year Old. The Journal of Pediatric, 145, 458-464.

[29]   Suen, J.S., Arnold, J.E. and Brooks, L.J. (1995) Adenotonsillectomy for Treatment of Obstructive Sleep Apnea in Children. Archives of Otolaryngology—Head and Neck Surgery, 121, 525-530.

[30]   Elsherif, I. and Kareemullah, C. (1999) Tonsil and Adenoid Surgery for Upper Airway Obstruction in Children. Ear, Nose, and Throat Journal, 78, 617-620.

[31]   Tarasiuk, A., Simon, T., Tal, A. and Reuveni, H. (2004) Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome Reduces Health Care Utilization. Pediatrics, 113, 351-356.

[32]   Peltomki, T. (2007) The Effect of Mode of Breathing on Craniofacial Growth—Revisited. European Journal of Orthodontics, 29, 426-429.

[33]   Vicini, C., Dallan, I., Campanini, A., De Vito, A., Barbanti, F., Giorgiomarrano, G., Bosi, M., Plazzi, G., Provini, F. and Lugaresi, E. (2010) Surgery vs. Ventilation in Adult Severe Obstructive Sleep Apnea Syndrome. American Journal of Otolaryngology—Head and Neck Medicine and Surgery, 31, 14-20.

[34]   Maurer, J.T. (2010) Surgical Treatment of Obstructive Sleep Apnea: Standard and Emerging Techniques. Current Opinion in Pulmonary Medicine, 16, 552-558.

[35]   Kee, K. and Naughton, M.T. (2009) Sleep Apnoea—A General Practice Approach. Australian Family Physician, 38, 284-288.

[36]   Hugentobler, M. and Scolozzi, P. (2010) Severe Dental Malocclusion: A Rare and Insidious Complication of Mandibular Advancement Devices for Obstructive Sleep Apnea Syndrome Treatment. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics, 109, e28-e32.

[37]   Sullivan, C.E., Issa, F.G., Berthon-Jones, M. and Eves, L. (1981) Reversal of Obstructive Sleep Apnoea by Continuous Positive Airway Pressure Applied through the Nares. The Lancet, 317, 862-865.

[38]   Rishi, M.A., Copur, A.S., Nadeem, R. and Fulambarker, A. (2015) Effect of Positive Airway Pressure Therapy on Body Mass Index in Obese Patients with Obstructive Sleep Apnea Syndrome: A Prospective Study. American Journal of Therapeutics, in Press.

[39]   Bian, H. (2004) Knowledge, Opinions, and Clinical Experience of General Practice Dentists toward Obstructive Sleep Apnea and Oral Appliances. Sleep Breath, 8, 85-90.

[40]   Wu, J.H., Hsu, C.Y., Wang, C.H., Lee, H.E., Lan, T.H. and Du, J.K. (2010) The Difference between Two Oral Appliances in Treating Obstructive Sleep Apnea: A Case Report. Journal of the Formosan Medical Association, 109, 163- 166.

[41]   Hoffstein, V. (2007) Review of Oral Appliances for Treatment of Sleep-Disordered Breathing. Sleep Breath, 11, 1-22.

[42]   Veis, R.W. (1998) Snoring and Obstructive Sleep Apnea from a Dental Perspective. Journal of the California Dental Association, 26, 557-565.

[43]   Cozza, P., Gatto, R., Ballanti, F. and Prete, L. (2004) Management of Obstructive Sleep Apnoea in Children with Modified Monobloc Appliances. European Journal of Pediatric Dentistry, 5, 24-29.

[44]   Cozza, P., Polimeni, A. and Ballanti, F. (2004) A Modified Monobloc for the Treatment of Obstructive Sleep Apnoea in Paediatric Patients. European Journal of Orthodontics, 26, 523-530.

[45]   Hoekema, A., Stegenga, B. and De Bont, L.G. (2004) Efficacy and Co-Morbidity of Oral Appliances in the Treatment of Obstructive Sleep Apneahypopnea: A Systematic Review. Critical Reviews in Oral Biology and Medicine, 15, 137- 155.

[46]   de Britto Teixeira, A.O., Abi-Ramia, L.B.P. and Almeida, M.A. (2013) Treatment of Obstructive Sleep Apnea with Oral Appliances. Progress in Orthodontics, 14, 10.

[47]   Schmidt-Nowara, W.W., Meade, T.E. and Hays, M.B. (1991) Treatment of Snoring and Obstructive Sleep Apnea with Dental Orthosis. Chest, 99, 1378-1385.

[48]   Knudson, R.C. and Meyer, J.B. (1993) Managing Obstructive Sleep Apnea. Journal of American Dental Association, 124, 75-78.

[49]   Engleman,, H.M., McDonald, J.P., Graham, D., Lello, G.E., Kingshott, R.N., Coleman, E.L., Mackay, T.W. and Douglas, N.J. (2002) Randomized Crossover Trial of Two Treatments for Sleep Apnea/Hypopnea Syndrome: Continuous Positive Pressure and Mandibular Reposition Splint. American Journal of Respiratory and Critical Care Medicine, 166, 855-859.

[50]   Walker-Engstrom, M.L., Wilhelmsson, B., Tegelberg, A., Dimenas, E. and Ringqvist, I. (2000) Quality of Life Assessment of Treatment with Dental Appliance or UPPP in Patients with Mild to Moderate Obstructive Sleep Apnea: A Prospective Randomized 1-Year Follow-Up Study. Journal of Sleep Research, 9, 303-308.

[51]   Gotsopoulos, H., Kelly, J.J. and Cistulli, P.A. (2004) Oral Appliance Therapy Reduces Blood Pressure in Obstructive Sleep Apnea: A Randomized, Controlled Trial. Sleep, 27, 934-941.

[52]   Barnes, M., McEvoy, R.D., Banks, S., Tarquinio, N., Murray, C.G., Vowles, N. and Pierce, R.J. (2004) Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 170, 656-664.

[53]   Yoshida, K. (2006) Effect on Blood Pressure of Oral Appliance Therapy for Sleep Apnea Syndrome. International Journal of Prosthodontics, 19, 61-66.

[54]   Rose, E.C., Schnegelsberg, C., Staats, R. and Jonas, I.E. (2001) Occlusal Side Effects Caused by a Mandibular Advancement Appliance in Patients with Obstructive Sleep Apnea. Angle Orthodontist, 71, 452-460.

[55]   De Almeida, F.R., Lowe, A.A., Tsuiki, S., Otsuka, R., Wong, M., Fastlicht, S. and Ryan, C.F. (2006) Long Term Compliance and Side Effects of Oral Appliances Used for the Treatment of Snoring and Obstructive Sleep Apnea Syndrome. Journal of Clinical Sleep Medicine, 1, 143-152.

[56]   Anandam, A., Akinnusi, M., Kufel, T., Porhomayon, J. and El-Solh, A.A. (2013) Effects of Dietary Weight Loss on Obstructive Sleep Apnea: A Meta-Analysis. Sleep Breath, 17, 227-234.

[57]   Bury, S.B. and Singh, A. (2015) The Role of Nasal Treatments in Snoring and Obstructive Sleep Apnoea. Current Opinion in Otolaryngology Head and Neck Surgery, 23, 39-46.

[58]   Kumar, A.R., Guilleminault, C., Certal, V., Li, D., Capasso, R. and Camacho, M. (2014) Nasopharyngeal Airway Stenting Devices for Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis. The Journal of Laryngology Otology, 29, 1-9.

[59]   Waldman, H.B., Hasan, F.M. and Perlman, S. (2009) Down Syndrome and Sleep-Disordered Breathing: The Dentist’s Role. Journal of American Dental Association, 140, 307-312.