Ronald Attanasio - Dental Management of Sleep Disorders

1 Cover

2 Title Page

3 Copyright Page

4 Dedication Page

5 List of Contributors

6 Preface

7 Section 1: Overview of Sleep Medicine 1 Impact of Sleep Disorders on SocietyConceptual Overview Conclusion References 2 Human SleepConceptual Overview Normal Sleep Conclusion References 3 Pathophysiology of Sleep‐Related Breathing DisordersConceptual Overview Normal Respiration Conclusion References 4 The Classification of Sleep DisordersConceptual Overview Classification Systems General Categories Conclusion References 5 The Relationship Between Sleep Disorders, Medical Conditions, and Your HealthConceptual Overview Conclusion References 6 Medications and SleepConceptual Overview Conclusion References

8 Section 2: Dentistry and Sleep Medicine 7 Dental and Orofacial Consequences of Sleep‐Related Breathing DisordersConceptual Overview Conclusion References 8 Pediatrics and Adolescent Sleep and Sleep DisordersConceptual Overview Conclusion References 9 Role of the Dentist in Sleep MedicineConceptual Overview Conclusion References 10 Other Sleep Disorders of ImportanceConceptual Overview Conclusion References 11 Practicing Dental Sleep MedicineConceptual Overview Conclusion References

9 Section 3: Assessment for Sleep‐Related Breathing Disorders 12 Screening for Sleep DisordersConceptual Overview Basic Questions Questionnaires for Screening Other Types of Screening Pediatric and Adolescent Questionnaires Conclusion References 13 The Clinical Evaluation by the DentistConceptual Overview What the Dentist Sees That May Indicate the Risk for an SBD The Clinical Evaluation for the SRBD Conclusion References 14 Imaging for Sleep‐Related Breathing DisordersConceptual Overview Conclusion References 15 The PolysomnogramConceptual Overview Conclusion References 16 Ambulatory Sleep TestingConceptual Overview Conclusion References

10 Section 4: Oral Appliance Therapy for Sleep‐Related Breathing Disorders 17 Oral Appliance Therapy for the Management of Sleep‐Related Breathing DisordersConceptual Overview Conclusion References 18 Fabrication and Delivery of the Oral ApplianceConceptual Overview The Impression Process Interocclusal Record – The Therapeutic Bite Registration Conclusion References 19 Follow‐up Care and Titration in Oral Appliance TherapyConceptual Overview Conclusion References 20 Adverse Effects and Their Management in Oral Appliance TherapyConceptual Overview Conclusion References

11 Section 5: Other Management Strategies for Sleep‐Related Breathing Disorders 21 Positive Airway Pressure TherapyConceptual Overview Conclusion References 22 Surgical Management for Sleep‐Related Breathing DisordersConceptual Overview Conclusion References 23 Alternative and Adjunctive Options for the Management of Sleep DisordersConceptual Overview Alternative Therapies Cognitive Behavioral Therapy for Insomnia (CBT‐I) Conclusion References

12 Appendix A: Abbreviations in Sleep MedicineConceptual Overview List of Abbreviations

13 Appendix B: Glossary of Terms in Sleep Medicine

14 Appendix C: Sample Patient Screening Questionnaires Epworth Sleepiness Scale Berlin Questionnaire STOP‐Bang Questionnaire NOSE Scale (nasal obstruction symptom evaluation) Pittsburgh Sleep Quality Index (PSQI) Insomnia Risk Questionnaire Dental Sleep Medicine (DSM) Quality of Life Survey References

15 Appendix D: Sample Evaluation Format for SRBD and Airway Clinical EvaluationIntroduction

16 Index

17 End User License Agreement

1 Chapter 1 Table 1.1 Common risk factors. Table 1.2 Prevalence of sleep problems with comorbid illness (age 55–84).... Table 1.3 Common health issues associated with sleep disorders.

2 Chapter 2 Table 2.1 Recommended hours of sleep by age. Table 2.2 Neurotransmitters of sleep and wake.

3 Chapter 3 Table 3.1 Muscles involved with the soft palate. Table 3.2 Muscles involved with the oropharynx. Table 3.3 Muscles related to the hyoid. Table 3.4 Muscles involved with the oropharynx. Table 3.5 Nerve supply to the muscles of the upper airway.

4 Chapter 5 Table 5.1 Risk of coronary artery disease (CAD) based on hours of sleep....Table 5.2 Risk for symptomatic diabetes based on hours of sleep.Table 5.3 Common symptoms of GERD.

5 Chapter 6Table 6.1 Effects of common medications on sleep.

6 Chapter 7Table 7.1 Evidence of an association and/or causality between SB and OSA [6...

7 Chapter 8Table 8.1 Health‐related conditions associated with SRBD in children and ad...Table 8.2 More common congenital conditions that predispose the child to SR...Table 8.3 General pediatric sleep questionnaire.Table 8.4 Symptoms and findings in children with SBD.Table 8.5 Clinical manifestations of sleep‐related breathing disorders in t...Table 8.6 Diagnostic values (AHI) for children and adolescents from PSG....

8 Chapter 9Table 9.1 Historical review of the dentist's role in sleep medicine.Table 9.2 Criteria for “qualified dentist” status – include at least one of...Table 9.3 Summary of hours of education in sleep medicine in dental educati...

9 Chapter 10Table 10.1 Common symptoms of narcolepsy (acronym for symptoms is CHESS).Table 10.2 Commonly encountered circadian rhythm sleep disorders.Table 10.3 Commonly encountered parasomnias in REM and NREM sleep.Table 10.4 Description of movement disorders (RLS, PLMD, and SB).Table 10.5 Appendix A – related medical and neurologic disorders.

10 Chapter 11Table 11.1 Comparison of limited and comprehensive involvement in OAT by th...

11 Chapter 12Table 12.1 Sleep Questionnaire for Pediatrics and Adolescents.

12 Chapter 13Table 13.1 Conditions that indicate the potential risk for a sleep breathin...Table 13.2 Steps for assessment of the patient at risk for the SRBD and sle...Table 13.3 Example of effect of Malampati score on OSA and AHI.

13 Chapter 14Table 14.1 Imaging options related to SRBD and mandibular repositioning....

14 Chapter 15Table 15.1 Levels of sleep studies.Table 15.2 Parameters of the polysomnogram (PSG).Table 15.3 Specifics of the MSLT and MWT.

15 Chapter 16Table 16.1 Guidelines for the use of HSAT devices.

16 Chapter 17Table 17.1 Basic history related to oral appliance therapy.Table 17.2 Various names for OAT.Table 17.3 Oral appliance therapy indications.

17 Chapter 18Table 18.1 Checklist for fabrication of the oral appliance.Table 18.2 Proposed protocol for the interocclusal record (IR) for OA thera...Table 18.3 Suggested features of informed consent for OAT.

18 Chapter 19Table 19.1 Proposed follow‐up protocol for OAT.

19 Chapter 20Table 20.1 Myofascial pain referral in the head, face and neck.

20 Chapter 22Table 22.1 Success vs cure for MMA surgery [16].Table 22.2 Exclusion criteria from STAR trial.

21 Chapter 23Table 23.1 Levels of recommendation – patient care strategy.Table 23.2 Body mass index (BMI) parameters and examples of BMI based on we...Table 23.3 Common nasal sprays.Table 23.4 Cognitive behavioral therapy‐I (CBT‐I).

1 Chapter 2 Figure 2.1 Sleep EEG. Figure 2.2 Sleep architecture/histogram over the ages. Figure 2.3 Sleep over the decades. Figure 2.4 The brain. CC, corpus callosum; HT, hypothalamus; ON, optic nerve... Figure 2.5 Release of melatonin.

2 Chapter 3 Figure 3.1 Evolution of SRBD based on the acquisition of speech and the loss... Figure 3.2 Illustration of the three regions of the upper airway: N, nasopha...

3 Chapter 5 Figure 5.1 Risk factors associated with OSA and the consequences [15].Figure 5.2 Oxidative stress: pathway to cardiovascular disease and atheroscl...

4 Chapter 8Figure 8.1 Adenoidal faces.Figure 8.2 Allergic shiners.Figure 8.3 Poor or inadequate lip seal.Figure 8.4 Small nares.Figure 8.5 Nasal crease.