27 May 2022

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Sleep breathing disorders in adult: role of orthodontist

Authors: Salvatore Ranieri, Giuseppina Laganà, Elisabetta Cretella Lombardo, Paola Cozza

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The International Classification of Sleep Disorders (ICSD) placed the Obstructive Apnea (OSA) in the sleep-related respira- tory disorders section. The term OSA refers to a respiratory disorder characterized by obstruction of the upper airways that involves a partial reduction (hypopnea) or complete cessation (apnea) of the airflow during sleep. The purpose of the following work is to provide the orthodontist with a series of updated “evidence based” recommendations and indications for the diagnosis and treatment of snoring and obstructive sleep apnea (OSA) in adults.

MATERIALS AND METHODS
A systematic analysis of the existing literature about OSA in adults was performed using the PubMed database and the following formula: sleep apnea AND oral appliance OR mandibular repositioning OR mandibular advancement OR Non-CPAP NOT orthognatic surgery NOT osteotomy NOT children. Additional filters were added: article types (Clinical Trial, Guideline, Meta-Analysis), publication dates (10 years), languages (english). The analysis of the publications was limited to studies conducted on humans. The guidelines of the “Società Italiana Medicina del Sonno Odontoiatrica” and the guidelines of the Italian Ministry of Health have been added to the selected publications.

RESULTS AND DISCUSSION
Snoring is an inspiratory noise that can originate from various anatomical sites, while obstructive sleep apnea (OSA) is attribut- able to the collapse of the upper airways that cause a partial (hypopnea) or complete obstruction (apnea) to the passage of air, with consequent decrease in blood oxygenation. The diagnosis requires a multidisciplinary approach in which the role of the sleep specialized doctor is fundamental in coordinating the team of specialists. The anamnesis allows to investigate the pres- ence of signs and symptoms related to OSA and to identify a patient potentially at risk. In addition, some diagnostic question- naires are useful for a first screening examination, which, however, could not replace the polysomnography, the exam consid- ered the “gold standard” for the diagnosis of OSA. Inadequately diagnosed OSAs can lead to serious complications for pa- tients’ health, increasing the risk of cardiovascular disease and road and work accidents. Treatment of OSAs requires a multi- disciplinary approach and must be planned and coordinated by the sleep specialized doctor and the therapeutic approach should be focused on the elimination of risk factors and the resolution of anatomical and non-anatomical determinant factors.

CONCLUSIONS
Considered the multiple complications which patients suffering from respiratory disorders might face, it is necessary to inter- cept such pathologies in early stages and insert the patient into a targeted and precise prevention and treatment program. In that precise context the role of the qualified orthodontist or dentist becomes fundamental for both the diagnostic and the ther- apeutic point of view. Given the complexity of the etiologic and pathophysiological factors concerning sleep disorders, diagnos- tic and therapeutic management requires a multidisciplinary approach.

CLINICAL SIGNIFICANCE
The orthodontist must have adequate preparation and training for both diagnosis and treatment of sleep disorders. The dentist plays the role of “diagnostic sentinel” who must be able to recognize early signs and symptoms related to the obstructive sleep apnea syndrome (OSA) in the adult population and guide the patient to the correct diagnostic procedure.