Dental Sleep Medicine Expands Into Higher Education

Dental sleep medicine (DSM) has come a long way since the AADSM’s start in 1991. Founded by eight dentists interested in treating obstructive sleep apnea (OSA), the Academy now provides training for more than 1,800 dentists via educational courses, peer-reviewed journals and study clubs.

Several universities have begun addressing the need for DSM education as well.

AADSM members Leopoldo Correa, BDS, and Noshir Mehta, DMD, MDS, MS, launched an innovative new DSM program at Tufts University in Boston, MA this past fall.

An article in the January/February issue of Sleep Review Magazine provides an overview of this exciting new program.

The curriculum caters to postgraduate dental students. These students have dental degrees and are doing advanced studies. They receive both classroom and clinical instruction.

Students learn how to screen patients for sleep apnea and interpret sleep studies. They learn how to fit and adjust oral appliances, and examine the pros and cons of different appliances.

There are more than 18 million Americans suffering from sleep apnea. Many of them do not know they have the disease. Dentists see their patients on a regular basis, so it is convenient for them to screen for sleep apnea. This screening ensures that more OSA patients get the treatment they need for a healthy life.

Dr. Correa explained that there are still not enough dentists trained in DSM to meet the patient demand. The course was designed to address that gap.

He explained why many dentists decide to learn DSM.

“Dental sleep medicine is a rapidly expanding field where the dentist has an immediate and direct effect on the overall health of the patient,” said Dr. Correa. “It is one of the growing number of examples where a medical and a dental practitioner can work together to benefit the patient more than either one alone.”

So far, the program has been well received. Tufts University will offer a new mini-residency program this April.

Image by: UBC Library Graphics

Sleep Apnea and Nighttime Urination

A recent study evaluated nocturia as a predictor of obstructive sleep apnea (OSA). Nocturia involves excessive urination at night. It can cause a person to wake up several times during the night to urinate.

Nocturia is a known symptom of sleep apnea. This study examined it as a potential screening tool. Snoring is already a common screening tool for OSA.

The study was published online by the journal Sleep and Breathing in October, 2009.

It involved more than one thousand adults who had sought help at a sleep disorders center. They were all older than 18 years of age.

Each person completed medical and sleep history questionnaires. They also took an overnight sleep study. Of the participants, 797 had sleep apnea, 777 reported snoring, and 839 reported nocturia.

Results show that self-reported nocturia can effectively predict OSA.

The researchers suggest that nocturia may be a useful screening tool for sleep apnea.

Research also shows that CPAP therapy for sleep apnea reduces awakenings to urinate.

Sleep and Breathing is the official journal of the American Academy of Dental Sleep Medicine.

Sleep Apnea – What a Headache!

Morning headaches are a common symptom of obstructive sleep apnea (OSA).

Past studies found that these headaches affect anywhere from 18 to 74 percent of OSA patients.

A study published last February in the journal Cephalalgia showed that morning headaches might trouble a third of OSA patients.

The study included 101 healthy individuals and 462 OSA patients.

An estimated nine percent of healthy participants reported morning headaches. In contrast, more than 33 percent of OSA patients suffered from headaches.

People with moderate and severe sleep apnea were most affected.

Morning headaches were more frequently reported by women and patients with a history of headaches.

The study did usher in good news, though.

CPAP treatment solved 90 percent of patient’s morning headache problems.

Continuous Positive Airway Pressure (CPAP) is the gold standard of OSA treatment. While safe and effective, 25 to 50 percent of OSA patients cannot tolerate or comply with CPAP.

Many people use oral appliance therapy as an alterative. Oral appliance therapy is performed by dentists trained in dental sleep medicine.

Trimming Down By Catching Up on Your Zzz’s

One of the hardest parts of detecting obstructive sleep apnea (OSA) is that most people do not realize their brain forces them awake throughout the night to breathe.

These unconscious arousals can happen hundreds of times a night, voiding the benefits of restorative sleep, draining a person of energy, and putting them at risk for obesity, no matter how long they stay in bed.

A new study in the Feb. 1 issue of the journal SLEEP found that not getting enough sleep could lead to obesity.

The study examined people’s sleep habits and weight gain in Japan.

During health checkups in 2006 in 2007, 35,000 men and women reported their sleep habits. Their weights and heights were also recorded.

An estimated six percent of the men who were not obese in 2006 became obese in 2007.

The researchers found that this weight gain and the development of obesity was higher in men who slept less than six hours. Men who slept five hours were more affected by weight gain that those who slept five to six hours.

Both men and women who slept seven hours had higher body mass indexes (MBI) in 2007 than in 2006 compared to those who slept seven to eight hours per night.

Interestingly, the researchers found that sleeping more than nine hours was associated with increased weight gain. They suggested that a confounder such as OSA, may have affected the results.

Teaming Up Against Sleep Apnea: Physicians and Dentists Collaborate to Help Patients

An article in today’s Times Herald-Record highlights the teamwork many dentists and sleep physicians use to treat sleep apnea.

In a quest to help his wife sleep, 52 year-old John Franco set out to cure his snoring.

After taking a sleep test – he found out his snoring was actually a sign of sleep apnea.

Franco tried everything from CPAP to surgery to treat his apnea. Finally, Franco’s journey led him to an unlikely spot – the dentist chair.

Franco’s dentist, AADSM member Dr. Thomas Littner, told him about a dental device that might improve his snoring and his health.

Snoring and sleep apnea happen when a person’s airway partially or completely collapses during sleep. Dentists are not permitted to diagnose sleep apnea. But after a person takes a sleep test and gets diagnosed with sleep apnea, a dentist can fit that patient with an oral appliance. This appliance keeps the patient’s airway open so they can sleep better.

Dr. Littner fit Franco with a custom-made device.

"It's comfortable," Franco said. "It did take time to get used to it, but I like it. And most importantly, I don't snore. My wife said so."

Dr. Littner is an OSA patient himself. He became interested in dental sleep medicine when he started using an oral appliance to improve his own sleep. To learn oral appliance therapy, he took courses with the American Academy of Dental Sleep Medicine.

Dr. Littner is on staff at Orange Regional Medical Center where he works with Dr. Alan Schaffer to treat obstructive sleep apnea. Dr. Schaffer is a fellow of the American Academy of Sleep Medicine.

Dr. Schaffer explained how sleep medicine often requires a team of professionals to improve patients’ health.

"This whole field sets itself up as a multidisciplinary approach in medicine. It's an alternative to our C-PAP breathing apparatus that our center recommends for sleep apnea. But we have some patients (like Franco) who cannot tolerate the C-PAP, so we send them to Dr. Littner to be fitted with an oral device. We complement each other very nicely."

Sleep Apnea Patient Tells the Wall Street Journal How an Oral Appliance Restored His Health

Wall Street Journal reporter Kris Maher recently investigated how patients get treated for sleep apnea when they “balk” at the “bulky masks” involved in CPAP therapy.

CPAP device manufactures are working to improve CPAP compliance by making the designs more comfortable.

In the meantime, 25 to 50 percent of patients do not comply with or tolerate CPAP. So where do they go for treatment?

One option is the dentist’s office.

There are more than 1,800 dentists who treat sleep apnea with oral appliance therapy. These devices work best for patients with mild to moderate sleep apnea.

Thirty-five year-old Dave Morton used to wake up from sleep choking. After taking a sleep test, he was diagnosed with sleep apnea and started using a CPAP mask.

"I was very stressed and couldn't sleep," Mr. Morton recalled. "I never woke up feeling refreshed."

After two years of on-and-off CPAP use, Mr. Morton switched to a dental appliance, which reduced his sleep apnea significantly.

"I'm happier and healthier," he said. "I can tell my brain is working better again."

Dental devices can have side effects such as jaw pain or tooth movement. However, compared to the risks of untreated sleep apnea, such as heart attack, stroke and diabetes, many patients accept the tooth movement.

Learn more about oral appliances.

As Clear as Black and White: Study Shows that Severe OSA Patients Have Lower Concentration of Gray Matter

A study published today in the journal SLEEP found that men with severe obstructive sleep apnea (OSA) have significantly less concentrated gray matter in multiple brain areas than healthy men of the same age.

“Gray matter” refers to the cerebral cortex. It is where most of the brain’s information processing takes place.

The study suggests that the memory and cognitive impairment frequently observed in OSA patients may relate to changes in brain structure.

The study involved 36 males with severe OSA. It compared their brain structures to that of 31 healthy males of matched age. The men’s mean age was 44 years.

The participants each took a sleep study. The OSA patients had a mean apnea-hypopnea index (AHI) of 52. This number indicates they partially or completely stopped breathing more than 52 times per hour during sleep. An AHI of more than 30 constitutes severe OSA. These pauses can lead to severe drops in blood-oxygen concentration.

The researchers used an MRI technique to characterize structural differences between the men’s brains. They looked to see if gray matter concentrations or volumes differed in OSA patients and healthy men.

The researchers found that gray matter concentration decreased in OSA patients without significant changes in volume of the matter.

They noted that more research would help determine if this loss occurs because of OSA, or if preexisting abnormalities contribute to the development of the disorder.