Sleep Disordered Breathing (Snoring and Obstructive Sleep Apnoea)

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The 3rd International Classification of Sleep Disorders (ICSD) classifies Sleep Related Breathing Disorders into 5 categories namely;

 

• Obstructive Sleep Apnoea Disorders

• Central Sleep Apnoea Syndromes

• Sleep Related Hypoventilation Disorders

• Sleep Related Hypoxemia Disorder

• Isolated Symptoms and Normal Variants (Primary Snoring, Groaning)

 

Further to appropriate medical referral and supported by diagnostic sleep study, Primary (habitual) Snoring, Upper Airways Resistance Syndrome (UARS) and Obstructive Sleep Apnoea Syndrome (OSAS) are conditions that can be managed with dedicated Oral Appliance Therapy (OAT).

 

“Primary Snoring” is a sound generated in the upper airway without episodes of complete (apnoea) or partial (hypopnoea) upper airway obstruction, respiratory effort related arousals (RERA’s) or hypoventilation during sleep. Often more of concern to the bed partner, snoring in this context is not associated with daytime somnolence (sleepiness), insomnia, cardiovascular or cerebrovascular events. A sleep study (PSG) is often required to rule out Obstructive Sleep Apnoea (OSA). Whilst adults can snore and not have sleep apnoea and have sleep apnoea and not snore, snoring in children is abnormal and typically associated with OSA.

 

In the absence of hypopnoeas and apnoeas, “UARS” represents periods of increased respiratory effort during sleep ending in arousal (RERA’s), without hypoventilation, commonly affecting premenopausal women and often associated with daytime fatigue, headaches, hypotension, snoring, cognitive deficit, ADHD, periodic limb movement during sleep (PLMS), anxiety and depression, personality change, decreased libido and Functional Somatic Syndrome (irritable bowel syndrome, fibromyalgia, orofacial pain, temporomandibular dysfunction, burning mouth syndrome, back pain and chronic fatigue).

 

Being the more common sleep related breathing disorder and affecting 2-4% of middle aged adults, “OSAS” is characterised by repetitive episodes of hypopnoeas and or apnoeas during sleep, hypoventilation and associated symptomatic comorbidity if not premature mortality. OSA results from a combination of inadequate or abnormal neuromuscular control and or anatomic narrowing of the upper airway. OSAS risk factors include obesity, nasopharyngeal restriction, craniofacial abnormalities, neuromuscular disease, hypothyroidism, sleep posture, tongue-tie, smoking, alcohol, sedatives, sleep deprivation, age, gender, genetics, ethnicity, menopause, ventilatory control instability and sleep stage.

 

Signs and symptoms include snoring, witnessed apnoeas, choking and gasping during sleep, nocturnal awakenings, non-refreshing sleep, excessive daytime somnolence, fatigue, insomnia, impaired cognition, concentration and memory, headaches, reflux (post nasal drip, excessive salivation, non-productive cough, dysphagia), mood and personality changes, anxiety and depression, PLMS, impaired quality of life, impaired relationships, workplace and motor vehicle accidents, cardiovascular disease (hypertension, coronary artery disease, atrial fibrillation, stroke, angina, congestive heart failure, myocardial infarction), reduced libido, impotence, nocturia or bed wetting, night sweats, type 2 diabetes, hypercholestrolemia, central obesity, increased risk of perioperative complications and arousal based parasomnias including confusional arousals, sleep walking, sleep terrors, sleep related eating disorder, nocturnal epilepsy and REM sleep behaviour disorder. OSAS represents a chronic disease demanding long-term management including behavioural therapy, continuous positive airway pressure (CPAP), oral appliance therapy (OAT - Mandibular Advancement Splints), surgery, other adjunctive measures and or combinations thereof.

 

Dr Lego has undergone postgraduate training in the field of oral appliance therapy for Sleep Disordered Breathing and works in close collaboration with medical and dental specialists in the field.