Diagnosing and comanaging patients with obstructive sleep apnea syndrome

Background, Obstructive sleep apnea syndrome, or OSAS, is a common, but und erdiagnosed, disorder that potentially is fatal. It is characterized by rep etitive episodes of complete or partial upper airway obstruction leading to absent or diminished : airflow into the lungs. These episodes usually last 10 to 30 seconds and result in loud snoring, a decrease in oxygen saturati on, and chronic daytime sleepiness and fatigue. The obstruction is caused b y the soft palate, base of the tongue or both collapsing against the pharyn geal walls because of decreased muscle tone during sleep. Potentially fatal systemic illnesses frequently associated with this disorder include hypert ension, pulmonary hypertension, heart failure, nocturnal cardiac dysrhythmi as, myocardial infarction and ischemic stroke. Clinical Implications, The classic signs and symptoms of OSAS may be recogn izable by dental. practitioners. Common findings in the medical history inc lude daytime sleepiness, snoring, hypertension and type 2 diabetes mellitus . Common clinical findings include obesity; a thick neck; excessive fat dep osition in the palate, tongue (enlarged) and pharynx; a long soft palate; a retrognathic mandible; and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Conclusions, Dentists cognizant of these signs and symptoms have an opportu nity to diagnose patients with occult OSAS. After confirmation of the diagn osis by a physician, dentists can participate in management of the disorder by fabricating mandibular advancement appliances and performing surgical p rocedures that prevent recurrent airway obstruction.