Dentists treating sleep apnea are concerned about opening the oropharynx during all phases of sleep so respiration can happen without compromise. Many patients, having had trouble breathing for years, have comorbid conditions such as chronic obstructive pulmonary disease. Being aware of such problems and understanding the relationship with sleep apnea helps the dentist know their patient and interact with other providers at a higher, more precise level.
Dental Sleep Practice subscribers can answer the CE questions to earn 2 hours of CE from reading this article. Take the quiz by clicking here. Correctly answering the questions will demonstrate the reader can:
- Implement advanced knowledge about airflow
- Recognize COPD
- Understand the relationship of airway and COPD with obstructive apnea
When we consider the sleeping patient we know that a cessation of breathing of 10 seconds or longer is an apnea which means there is no airflow. When we measure chest and abdominal effort we can separate an obstructed breath from times when the brain isn’t stimulating any breathing activity. A hypopnea is a shallow breath with a corresponding oxygen desaturation. The Apnea Hypopnea index or AHI is the sum of these events divided by the number of hours
But what if the patient has a compromised breathing pattern during the day? If the patient presents with wheezing, chronic cough, shortness of breath or blueness of the lips or fingernail beds the patient may have COPD, comorbid with their Sleep Apnea. This is a condition known as overlap syndrome.
For a patient to respond well to any sleep apnea therapy it is critical that the patient have sufficient lung function to breathe properly on their own. COPD affects approximately 20 million people in the United States and is the nation’s third leading cause of death.
Xavier Soler, MD, PhD, Assistant Professor of Medicine, Pulmonary and Critical Care Division, University of California San Diego, reports in his national COPD foundation Blog that:
“Patients with severe COPD commonly exhibit abnormal sleep contributing to chronic fatigue, daytime sleepiness. Additionally, medications used to treat COPD, such as albuterol or prednisone, may affect sleep quality. A reduction of nocturnal oxygen levels commonly seen in patients with COPD can have profound effects and contribute to long-term sequelae, producing arrhythmias, myocardial stress, and, possibly, lower survival. OSA occurs in about 10 to 15% of patients with COPD, a condition referred to as the “overlap syndrome”. Although the prevalence of OSA is similar in patients with COPD as in the general population, individuals with both conditions without CPAP treatment have an increased risk of death and more hospitalizations from acute exacerbations.”
Lung function can be objectively measured using a lung function test called spirometry (CPT 94375).