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Inside Dentistry
August 2016
Volume 12, Issue 8
Peer-Reviewed

The sleep study data are inspected and scored for respiratory events. An apnea (A) is scored when airflow ceases for 10 or more seconds in adults. A hypopnea (H) is scored when airflow decreases for 10 or more seconds, along with other criteria. The criteria established by the American Academy of Sleep Medicine—generally accepted as the authority on sleep medicine in the United States—can differ from the criteria required by some third-party payers for treatment, explaining why some patients may receive a diagnosis of OSA yet may not meet criteria for insurance coverage of treatment.14 A respiratory effort related arousal (RERA) is scored when the patient arouses from sleep due to the increased respiratory effort to maintain normal airflow and blood oxygen levels.15

The severity of SDB is defined as the frequency of apneas plus hypopneas per hour. An apnea-hypopnea index (AHI) of ≥5 events/hour is considered mild OSA; ≥15 events/hour, moderate OSA; and ≥30 events/hour, severe OSA.16 Although an AHI of <5 events/hour is considered normal, epidemiological studies have shown that these individuals are at increased risk of diseases such as cardiovascular disease and periodontal disease.17,18 Moreover, patients with a normal AHI but with RERAs often report the same debilitating daytime symp­toms of OSA, such as excessive daytime sleepi­ness and cognitive impairment.

References

1. National Sleep Foundation 2005 Sleep in America Poll. https://sleepfoundation.org/sites/default/files/2005_summary_of_findings.pdf. Published March 29, 2005. Accessed October 3, 2015.

2. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.

3. Huang QR, Qin Z, Zhang S, Chow CM. Clinical patterns of obstructive sleep apnea and its comorbid conditions: a data mining approach. J Clin Sleep Med. 2008; 4(6):543-550.

4. Abrams B. Hierarchy of comorbidity indicators for obstructive sleep apnea. Chest. 2010;137(6):1491-1492.

5. Hiestand D, Phillips B. Obstructive sleep apnea syndrome: assessing and managing risk in the motor vehicle operator. Curr Opin Pulm Med. 2011;17(6):412-418.

6. Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009;5(6):573-581.

7. Tsuiki S, Isono S, Ishikawa T, et al. Anatomical bal­­ance of the upper airway and obstructive sleep apnea. Anesthesiology. 2008;108(6):1009-1015.

8. Remmers JE, deGroot WJ, Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol. 1978; 44(6):931-938.

9. Fietze I, Quispe-Bravo S, Hansch T, et al. Arousals and sleep stages in patients with obstructive sleep apnoea syndrome: Changes under nCPAP treatment. J Sleep Res. 1997;6(2):128-133.

10. Guilleminault C, Partinen M, Quera-Salva MA, et al. Determinants of daytime sleepiness in obstructive sleep apnea. Chest. 1988;94(1):32-37.

11. Capdevila OS, Kheirandish-Gozal L, Dayyat E, Gozal D. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc. 2008;5(2):274-282.

12. Arnardottir ES, Mackiewicz M, Gislason T, et al. Molecular signatures of obstructive sleep apnea in adults: a review and perspective. Sleep. 2009;32(4):447-470.

13. Collop NA, Anderson WM, Boehlecke B, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2007;3(7):737-747.

14. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2012;8(5):597-619.

15. Guilleminault C, Stoohs R, Clerk A, et al. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993;104(3):781-787.

16. Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.

17. Asker M, Asker S, Kucuk U, Kucuk HO. An overlooked cause of resistant hypertension: upper airway resistance syndrome—preliminary results. Clinics (Sao Paulo). 2014;69(11):731-734.

18. Sanders AE, Essick GK, Beck JD, et al. Perio­dontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos. Sleep. 2014.

About the Authors

Gregory K. Essick, DDS, PhD
Professor
Department of Prosthodontics and Center for Pain Research and Innovation School of Dentistry
University of North Carolina
Chapel Hill, North Carolina

Jonathan A. Parker, DDS
Owner
Clinical Director
Snoring and Sleep Apnea Dental Treatment Center Edina, Minnesota

Jamison R. Spencer, DMD, MS
Director
The Center for Sleep Apnea and TMJ
Boise, Idaho

Andrew R. Blank, AAS, BS
Dental Student
East Carolina University School of Dental Medicine
Greenville, North Carolina

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