PATIENTS - Frequently Asked Questions
1. What is sleep apnea?
2. How common is this disorder?
3. How would I know if I have OSA?
4. How do I get treatment for OSA?
5. Will my insurance cover this therapy?
These terms describe parts of the continuum of airway collapsibility expressed as sleep-disordered breathing. This spectrum ranges from slight vibration of tissues at its mildest to death from asphyxiation at its severe extreme. Between lies pathologic snoring and periods of complete airway closure and breathing cessation called "apnea".
Some of the most serious chronic diseases of man have been associated with snoring and sleep apnea, including: stroke, hypertension (high blood pressure), myocardial infarction (heart attack), arteriosclerosis (hardening of the arteries), cardiac arrhythmias (irregular pulse), diabetes, gastro-esophageal reflux disorder (GERD), polycythemia vera (thickening of the blood) and others.
Sleep disordered breathing also disrupts the normal patterns of brain activity and relaxation, precluding restorative sleep. Overwhelming daytime sleepiness contributes to the risk of accident and injury from decreased attention span, judgment and reflex. The risk of automobile accident in the untreated sleep apnea patient is about 8 times that of the normal sleeper. Work productivity and safety suffer.
During the increasing muscular relaxation of deepening sleep, the airway can become increasingly flaccid. The relaxing tongue falls back, sealing against the back of the throat during the sucking, negative pressure of the attempt to take a breath. Snoring is the vibration of the uvula, soft palate and throat walls against the tongue during the inspiratory phase of breathing, with reduced airflow due to increased resistance. As collapsibility increases, complete closure can occur.
In either narrowing (hypopnea) or closing (apnea) events, oxygen levels of the blood can drop precipitously triggering a response of the brain to prevent asphyxia. This "sympathetic discharge" of adrenaline, corticosteroids and other agents raise blood pressure, pulse rate, muscle activity and brain activity to protect the unconscious sleeper from death.
The sleep apnea patient may have these events occur up to 600 times or more per night resulting in fragmented, non-refreshing sleep as well as chronic activation of the sympathetic nervous system. This activation is thought to be the reason for such devastating long-term negative effects on cardio-pulmonary health. Untreated for nine years, sleep apnea patients may lose 20-50% of lifespan.
NORMAL AIRWAY | 
COMPROMISED AIRWAY |
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Recent research estimates that about 1/3 of the population has some form of sleep disordered breathing which is a spectrum of severity from mild snoring to complete closures of the airway (obstructive sleep apnea) to death from asphyxiation.
17% of the population has obstructive sleep apnea, and in the age groups over 60 years, the occurrence rate doubles. Sleep apnea is made worse with increasing body weight. As the obesity rates are rising in the United States, so is the incidence and severity of Obstructive Sleep Apnea (OSA)
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Several peer-reviewed research articles have examined the relationship between patient medical history and sleep testing for the presence of OSA.
If you answer "yes" to two questions:
1 - "Do you snore regularly?" and
2 - "Do you sometimes gasp for air?"
there is an 88% chance of accurately diagnosing OSA at a severity level of 10 collapses per hour. This is significant and requires treatment.
Adjusted Neck Circumference Survey for OSA
New England Journal of Medicine 347:498-504, 2002
The adjusted neck circumference survey uses 4 predictors of OSA to screen patients for the likelihood and possible severity of the disorder.
| 1. |
Neck circumference in cm (2.5 X inches)
| ENTER
MEASUREMENT |  | | 2. |
History of high blood pressure
(treated or not)
| ADD 4 | |
| 3. | Snoring
| ADD 3 | |
| 4. | Gasping or choking in sleep
(observed or awakened)
| ADD 3 | |
| | TOTAL
SCORE | |
Probability of Obstructive Sleep Apnea
Less than 44 = LOW
44 - 48 = MODERATE
Greater than 49 = HIGH
|
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Any practitioner treating OSA should do so by practice parameters established by the American Academy of Sleep Medicine (AASM). To be in compliance, patients must be diagnosed by polysomnography (PSG) which is an overnight sleep test at a sleep laboratory. 16 channels of physiology are studied including brain function and cardio-pulmonary status.
All SMN Affiliate dentists are trained to practice in accordance with AASM practice parameters.
| 1. |
Get an evaluation appointment with an SMN Affiliate dentist, or contact SMN for assistance. Referrals for diagnostic sleep testing can obtained at that visit if you have not been tested. If you have been tested and are looking for treatment, the dentist will be able to make sure that you are fully informed of all treatment options available. |
| 2. |
If you select oral appliance therapy, the SMN Affiliate Dentist will provide standardized care with proper informed consent, proper follow up therapy and objective measurement of results in accordance with AASM standards of care. |
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5. Will my insurance cover this therapy?
SMN Affiliate Dentists have access to SMN's effective medical insurance management systems. It is very likely that your medical insurance carrier will cover oral appliance therapy for you. SMN can offer a complete insurance assessment at the initial visit. This assessment, prior to accepting any therapy virtually eliminates patient uncertainty over any financial obligations. Contact SMN for complete details.
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