Relationship between obese youth and sleep apnea

There is an increasing prevalence of children and adolescents with obesity causing a global health concern. While the effect of obesity on cardiovascular function has been investigated, little remains known about how it impacts obstructive sleep apnea in youth with obesity.

In a recent study from the American Journal of Cardiology, researchers looked at the influence of OSA on cardiovascular functional parameters in obese youth. The study looked at 44 obese patients and 44 age- and gender-matched control subjects. Every patient underwent polysomnography and cardiovascular assessment.

The study found that patients with obesity had:

  • Higher left ventricular (LV) mass/height 2.7,
  • Preserved LV systolic parameters.
  • Differences in LV diastolic parameters.
  • Increased PWV and systolic blood pressure at rest compared with control group.

For youth with obesity, 32 percent had obstructive sleep apnea. However, there was no correlation between obesity and the apnea-hypopnea index (AHI). The LV mass/height 2.7 significantly correlated with body mass index z-score whereas PWV correlated with AHI. The body mass index z-score for patients with obesity was an independent predictor for LV mass/height 2.7 and AHI was an independent predictor for higher PWV.

From this study we understand that both obesity and OSA influence cardiovascular performance in youth with obesity. And while obesity is associated with increased LV mass and reduced LV diastolic function, obstructive sleep apnea is associated with changes in arterial stiffness.

Add this to the list for reasons to not only treat sleep apnea, but also offer lifestyle change suggestions for children and adolescents to further prevent complications.

Guidelines for treatment of sleep apnea with oral appliance therapy

In the first official joint guideline from the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM), oral appliance therapy is recommended for the treatment of adult patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure (CPAP) therapy or prefer alternate therapy.

This AASM and AADSM guideline supports increased teamwork between physicians and dentists to achieve optimal treatment of patients with OSA. While their recommendations were published in 2015, it is important that we make sure we are familiar with them. Their recommendations are vital to our care for our patients with sleep apnea.

The AASM and AADSM have six recommendations for dentists to follow.

  1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD)
  2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE)
  3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD)
  4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE)
  5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE)
  6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE)

For more information on their recommendations, such as the summary for each, download the document. I hope this helps moving forward for a better understanding of what the AASM and AADSM recommend for treatment of sleep apnea with oral appliance therapy.  

Start planning for 2019: Sign up for these pain courses

If you’re like me then you like to plan ahead. There are times you might wish you knew about a dental sleep medicine (DSM) course sooner than the week before–believe me, I get it. Well, to help those who are planners, here are three DSM courses at the start of 2019 you can plan ahead for!

March 15-17, 2019, Orofacial Pain Mini Residency Session 1 in Atlanta. This is a comprehensive two-session, 38 CE Credit program designed to give dental practices the knowledge and guidance to fully incorporate orofacial pain treatment into their practice. The program is led by industry mentors Dr. Mayoor Patel, DDS, MS, RPSGT, D.ABDSM, DABCP, DABCDSM, DABOP and former AACP president Dr. Terry Bennett, DDS, D.ABDSM, D.ABCP, D.ABCDSM.

With an emphasis on hands-on learning, attendees gain the skills and confidence needed to be successful in all aspects of TMD & craniofacial pain treatment. The first session will consist of:

  • Neuroanatomy.
  • The concepts and fundamentals of pain.
  • Musculoskeletal disorders.
  • Neuropathic disorders.
  • Neurovascular disorders.
  • Hands-on examination and documentation systems.
  • Medical billing for TMD treatment.

April 26-27, 2019, The Appliance Course for Dental Sleep Medicine & TMD in Scottsdale, AZ. There are so many obstructive sleep apnea and TMD appliances in the dental market, so how do you know which one to choose for which patient? It might be a bit overwhelming, but that is where this lecture helps. The Dental Sleep Medicine and TMD appliance course is a two-day journey towards increasing your mastery of dental sleep medicine and TMD appliances. In this course you will learn:

  • The pros and cons of each major appliance, and which one is right for each patient.
  • How to develop communication protocols with patients and dental labs for more successful outcomes.
  • Comprehensive exams and hands-on bite registration techniques.
  • Triaging between sleep apnea and TMD treatment.
  • The latest medical billing policies, codes, and best practices for successful reimbursement.

June 14-15, 2019, Orofacial Pain Mini Residency Session 2 in Atlanta. Session two of the Orofacial Pain Mini Residency will cover imaging, pharmaceuticals, and adjunct therapy for orofacial pain. Therapy for craniomandibular disorders, orthotic therapy, and a review of other common orofacial pain conditions is covered before diving into hands-on injection therapy, and closing with sleep and pain, and case studies.

To learn more about upcoming lectures, please visit http://mpateldds.com/upcoming-lecture/. I look forward to seeing you an an upcoming lecture or mini-residency covering the topic of pain!

3 dental sleep medicine courses to start 2019 with

As with every New Year, we always want to start with our best foot forward. I know it is only November, but now is the time to get started on your preparation for 2019. If you start now, you can get the best deals on airfare (if needed) and hotels.

Here are three dental sleep medicine courses to attend in the first couple months of 2019.

January 25-26 in Jupiter, Florida. The topic is TMJ for the Dental Sleep Medicine Practice. In this lecture we will take a look at the connection between TMD and sleep apnea. With 36 states now mandating TMD coverage in health care plans, it is important to understand how to incorporate these services into your practice. A dental professional is the primary care provider for TMJ dysfunction because they are capable of significantly improving the quality of life and overall health of these patients. And in the realm of dental sleep medicine, the American Academy of Sleep Medicine practice parameters for OSA put the responsibility clearly on dentists to catch and treat TMD problems in sleep apnea patient follow-up exams. Sign up for this course to gain step-by-step guidance on identifying, diagnosing and implementing TMD treatment.

February 8-9 in Atlanta, Georgia. If you have not already attending the first three sessions, this might not be for you. However, it is a great sleep and pain mini residency. Session 4 is the last of this mini-residency 2. The program is designed to give dental practices the knowledge and guidance to fully incorporate obstructive sleep apnea treatment into their practice. It also aims to help dentists overcome obstacles in order to grow and flourish in dental sleep medicine.

March 8-9 in Atlanta, Georgia. This is the third installment of the Sleep and Pain Mini Residency. If you weren’t able to sign up for the previous sessions, now is the time to sign up for session one! This is a 4-part, 64 CE credit program led by Dr. Mayoor Patel and Dr. Terry Bennett. By attending this mini-residency series you will learn about dental sleep medicine with an emphasis on hands-on and practical learning. Dentists will gain the skills and confidence they need to incorporate sleep apnea treatment into their practice successfully.

To learn more about upcoming lectures, please visit http://mpateldds.com/upcoming-lecture/. I look forward to seeing you an an upcoming lecture or mini-residency!