40% of the population snores whilst asleep, due to the bad ventilation of the respiratory airways. A correct respiration has a fundamental influence on diurnal performance. This syndrome is one of the most prevalent ones, as it not only alters negatively the quality of life of those whose suffer from sleep apnea, but also their beloved ones. It is very important to distinguish between an annoying noise (simple snoring), produced by an insufficient amount of air getting in your respiratory conducts, and snoring caused by sleep apnea (Sleep Apnea Hypopnea Syndrome, SAHS). These awake the patient continuously, causing possible heart failures and cerebro-vascular damages.When the oropharyngeal musculature relaxes, apart from emitting an undesirable noise, the patient suffers from micro-awakenings (arousals) which lead to a restless sleep.
“Simple snoring appears to be an annoying problem, however your health is not altered. On the other hand, when snoring is accompanied by apnea, the issue must be treated as a serious matter as your health status is compromised. It all depends on the number and the severity of the apneas.” explains doctor Fernando Loscos Morato, head of the Loscos dental clinic in Zaragoza. It is estimated that 90% of patients with apnea are completely undiagnosed.
In general, the pneumonologist is the person in charge of identifying the syndrome using a polysomnographic screener (sleep study). According Armando Poromingo, also head of the Pormingo Dental Clinic “ Finally it is the pneumonologists’ decision who selects the most adequate treatment”. In some cases, the patient can be treated with surgery, such as urgent throat- or jawsurgery, in which the respiratory tracts are modified in order to increase their size. Along non-surgical treatments, the most effictive option against sleep apnea is the use of the mechanical continuos positive airway pressure (CPAP) machine. The machine restores normal breathing by stabilizing the upper airways.
However, odontology also plays a big roll in sleep medicine, with the use mandibular advancement devices (MAD). A 90% effectiveness is guaranteed through this method in cases of aggressive snoring and 75% in cases of apnea. “The patient wears a splint, which moves the patients’ mandibular forward, allowing a proper ventilation” explains Fernando Loscos.
Furthermore, in some extreme cases both CPAP and intraoral devices may be used at the same time “OPAP, oral pressure appliance, do the same job as CPAP, but in this case the mask is substituted by a device, along with the continuos air pressure which produces a mandibular advancement” claims this specialist. Also, in patients with severe sleep apnea who can not tolerate CPAP, MAD’s, although not being a perfect solution, can help immensely. “Many people combine both; CPAP at home and alternatively the MAD when their abroad” declairs Pordomingo.
The appliances are always tailor-made, according to specific measures of the patients both lower and upper arcades. The most complicated issue is to determine the mandibular advancement as a provisional option, one may use the MAD to determine the perfect fit. “Every month we check up the patient increasing the protrusion to detect the most ideal position” explains Armando Pordoming. Generally, 70% of advancement fullfill the purpose, but we have to take into account that each patient is different and likewise the specific main characteristics of each patient. Although MAD is not supported by the public health insurance, except in Cantabria, the device costs half as much as a CPAP machine.