Does treating sleep apnea improve diabetes management?

Managing diabetes requires a “day-in, day-out” effort to control the factors that affect blood sugar levels. And what might make it even more difficult to manage symptoms is if you suffer from obstructive sleep apnea. A study conducted by a team of scientists, including two professors at the West Virginia University School of Medicine, is working as part of a multi-center project sponsored by the National Institutes of Health.

The team of researchers looked to assess what impact treating obstructive sleep apnea has on diabetes self-management. Let’s take a look at what impact treating OSA has on diabetes self-management for our patients.

What is the connection?

OSA is a common disease that is linked to a range of problems in patients with diabetes and those who do not suffer from this condition. From poor work performance to heart failure, sleep apnea is the reason behind many health conditions. It can even make patients with diabetes less sensitive to their insulin.

In a recent study, researchers split patients in half. One half used a CPAP machine to treat their sleep apnea, while the other half used a mock CPAP machine that looks and feels like a regular machine, but does not impart any of its benefits. Throughout the study patients also underwent periodic blood sugar checks.

While the study has not concluded yet, researchers are hopeful that treatment of sleep apnea will help improve diabetes self-management in their patients. If the study does show that using CPAP machines improves blood sugar control in patients with diabetes and sleep apnea, there will be no reason why we should not screen more of our patients with diabetes for OSA.

If a patient has been diagnosed with sleep apnea, physicians can persuade them to use CPAP machines regularly. This can work with oral appliances too. Patients with diabetes struggle so much with their sugar levels. This study can provide some relief knowing there is another option to help improve their health.

I know this study doesn’t focus on oral appliances. But should look to oral appliance therapy as a safe alternative to CPAP for our patients.

Pay attention to dental side effects during long-term oral appliance therapy

We understand how successful treatment of obstructive sleep apnea (OSA) can be. However, we need to pay attention to the potential side effects from long-term oral appliance use. If we are aware of these side effects, we can help educate our patients and prevent them from occurring and interrupting care.

What do we do as dentists to help?

I have read several studies that looked at the predictors of dental changes associated with long-term treatment with oral appliances in patients with OSA. From these studies I have found that yes, long-term use can lead to dental complications if we do not educate our patients.

Before you fit your patient for an oral appliance, ask them if they are willing to take at least two-minutes out of their morning to perform exercises. That’s all it takes. Just two minutes (maybe even less) a day to prevent further complications. And, of course, if they do notice any shifts in their teeth, it is important for them to keep you up-to-date. You can provide an adjustment to their treatment or offer other solutions to improve this change.

When you are fitting your patients for their oral appliance, let them know that it is important to perform daily exercises after removal of the device. By performing jaw exercises, it can help prevent the patient’s mouth from becoming stiff or sore. It can also help to prevent lock-jaw and other complications.

It is our duty as dentists to take care of our patients and that means proper education for daily exercises after removing the oral appliance each morning.

What are you doing to help your patients through the oral appliance process? Are you having them perform exercises? If so, what kind? I am interested in learning what everyone is doing to help their patients each step of this journey.

Minimizing mandibular advancement in oral appliance therapy

In a recent study from the journal Sleep Medicine researchers looked at the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA). There is currently no gold standard method to fine-tune the mandibular advancement. This study was created to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea.

What were the results?

The researchers proposed the use of a multiparametric titration protocol to optimize the mandibular advancement. Thirty percent of the sample population exhibited the best results without any mandibular advancement and low frequency of side effects were observed. There were 36 patients involved in this study (22 were men) with a mean age of 57 years.

The mean mandibular advancement was between 1.7 and 1.5 mm achieving about 50 percent reduction in AHI in 72 percent of the patients. There were also 27 patients with an AHI of 10. Of the 21 patients with moderate to severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement of about three millimeters.

Researchers found that monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for proper treatment of OSA. What are some other ways to help improve oral appliance therapy results with our patients?

Why don’t more sleep physicians recommend oral appliances for OSA?

It’s an important question that many of us continue to wonder about – why aren’t more sleep physicians recommending oral appliances for sleep apnea? Well, to begin with, there appears to be a lack of data on the subject. While most dentists understand the importance of using oral appliances for the treatment of sleep apnea, physicians are still not in the know. So let’s get them some data.

What information is out there?

After doing a quick search through Google Scholar I found the following studies that showcase how effective oral appliances are for the treatment of sleep apnea in our patients:

Another reason is because they may not be comfortable with the process. If that is the case, then we must help them get more acquainted. This can be done by contacting their offices and educating them on the services we provide. Through proper education and understanding, you can help sleep physicians become better acquainted with oral appliance therapy as a successful alternative to the CPAP machine.

They are ignorant about topics they know little about, which is why it is important to educate them on oral appliances. Look up studies, attend classes and do what you can to provide the information they need to better understand this treatment alternative so we can all continue to help patients get a better night’s sleep.