Hypertension and cognitive decline: Implications of obstructive sleep apnea

In the general population we see a significant amount of people with hypertension and dementia. Hypertension has been shown to be a risk factor for Alzheimer’s dementia and vascular dementia, but it is also strongly connected with obstructive sleep apnea. Recent evidence suggests that sleep apnea is linked with cognitive decline and dementia. 

This proves that it is possible that sleep apnea is the final common pathway linking hypertension to the development of dementia. And since sleep apnea is readily treatable, such therapy could potentially delay or prevent the onset of dementia. 

What are the connections?

Recently, hypertension has been recognized as a risk factor for cognitive decline and dementia. Both of these conditions are also commonly seen in the general population. However, a significant number of patients with hypertension remain untreated, which can increase their risk for developing long-term negative health consequences. 

Sleep disordered breathing, or sleep apnea, is also highly prevalent in the general population and is associated with several adverse cardiovascular outcomes. Sleep apnea has been linked to incident and prevalent hypertension in various studies. It is also thought that sympathetic overactivity leads to the development of high blood pressure in these individuals. It is possible that sleep apnea contributes to the increased risk of cognitive decline and dementia seen in those with hypertension. 

Treat patients with sleep apnea now

This means it is important as dentists to provide proper treatment for our patients with sleep apnea. Through oral appliance therapy, you can take the next step toward improving your patients’ overall health and well-being. 

For this reason it is extremely important to properly screen your patients each time they visit your office. In doing so, you may be the first to notice a problem. From there you can refer your patient to a sleep physician for further diagnosis and treatment planning. 

It is our duty as dentists to continue to provide for our patients, especially knowing the connections between sleep apnea and other conditions. 

Hypertension affects your patients’ whole body 

We know there are so many connections between certain conditions and sleep apnea. One condition is hypertension. As you know, it can have harmful effects on a person’s body if left untreated. However, did you know that sleep apnea shares the same exact risks as hypertension? By treating sleep apnea, it can potentially save your patients’ lives.

To help you share this important information with your patients, I have created an educational infographic below. 

Feel free to download this infographic and share it with your patients. The more they know, the better we can treat their condition and keep them healthy.

Why do dentists, physicians ignore AHI number recommendation?

When told blood pressure is this number, we pay attention. When we are told AHI is this number, we don’t care. Why is it that we take this number so lightly? I think this is just as important to pay attention to as any other condition. Just as we care about BP measurements, we should also care about apnea hypopnea index, or AHI. I can’t say exactly why the AHI number recommendation goes ignored. But to help, let’s take a closer look at what AHI means for sleep apnea and our patients.

What is AHI?

It is the average number of combined apneas and hypopneas per hour. This helps to determine the severity of a person’s sleep apnea. Here is what to look for:

  • Normal sleep: Fewer than 5 events per hour.
  • Mild sleep apnea: 5 to 14 events per hour.
  • Moderate sleep apnea: 15 to 29 events per hour.
  • Severe sleep apnea: 30 or more events per hour.

While this scale is only for adults, children tend to be less likely to experience sleep apnea episodes. However, most specialists see an AHI above 1.5 as abnormal in children. They typically need treatment if their AHI is 5 or higher.

Treating sleep apnea

Patients with moderate or severe AHI scores may need to use a CPAP machine while sleeping. However, as many of you know, not all of our patients are adherent to the CPAP or can’t tolerate it. When this is the case, it is important to identify oral appliance therapy as an alternative treatment for their sleep apnea.

Lifestyle changes might also be something that you, or their physician, discuss. These changes will often include weight loss, exercising, smoking cessation and changing sleeping position, such as flipping from the back to sleeping on the side or stomach. These lifestyle changes are especially important for those with mild sleep apnea to try to minimize health comorbidities.

What are some ways to improve understanding of AHI numbers and how we can help our patients? I am open to hearing what you all do to continue to help your patients with sleep apnea.

Use technology to reach more patients for sleep apnea care

With an active social network, you can continue to reach your patients and even medical professionals with important information. From sharing educational blog posts to statuses about your practice, and even articles from around the Internet, your social network stands as a vital go-between you and your patients. Let’s take a look at how you can re-examine your social network to help reach more patients for sleep apnea care.

Post consistently. By understanding when people are utilizing the Internet, you can plan out your sharing and posting. For example, most people will go on Facebook, Twitter and Instagram when they first wake up in the morning, at lunch time, after work and then again before bed. If you stick to a time around those indicated, you can further improve your outreach to your patients.

Share important information. Pay close attention to what you are sharing on your social network. Is the information you are posting relatable for your patients? Is it something they really want to know? Think about questions that your patients frequently ask you and utilize information that answers those questions. You can help educate your patients about dental sleep medicine by answering questions, providing resources, sharing images and giving tips.

Social media is the easiest way to educate your patients on your specific area of interest, including sleep apnea or craniofacial pain. Whether you share outside articles or write your own, these social channels are available for you to further reach your patients in any way possible. Let them know that you are available and listening.