Expert in orthodontics, the renowned dentist Marina Población has more than 30 years of experience. She has been the director of the Pre and Post-surgical Orthodontics Service of Maxillofacial Surgery at the Hospital de la Princesa and is an honorary professor at the Autonomous University of Madrid. In the following article, explain everything you need to know about sleep apnea.
How to diagnose sleep apnea?
In 1989 the polysomnographer appears, which has been a great step forward in the history of medicine, since it has allowed to objectively diagnose sleep apnea. Until then, only the signs and symptoms were the only thing that the professional had to make a diagnosis, with a high error rate.
Today we can say exactly if a patient has sleep apnea , although there is a problem: the evolution of the airway (VA). This decreases with age; It grows until the age of 20 and begins a slight decrease until age 50. From that age, it decreases dramatically.
Fortunately, today the CBCT offers us a 3D image in which we can see where the VA is diminished and we can predict, if it is not diminished at the time of the test, the possibilities of having it past 50 years (given the measurements what can we do about the most diminished areas and where they are).
Risk factors for sleep apnea
- Alteration in the craniofacial growth, which consists of a deficiency in the sagittal plane of the face, either only of the jaw or maxillomandibular, that is, those people who have the chin and, therefore, the jaw much smaller than what corresponds in relation to the rest of the face, or also the middle third of the face. This small deficit of forward growth of the facial bones prevents the growth of the VA at normal size.
- Obesity, mainly in women; To the generalized overweight, the increased weight of her breasts is added to the ribs, making it difficult for the chest muscles to completely expand the ribs to allow maximum air intake.
- The wide neck above 42 cm, which is usually also linked to obesity but not always.
- In children the main cause is tonsil hypertrophy and vegetations.
If a maxillary compression is added to this pathology, a very frequent situation, the symptoms multiply exponentially.
Symptoms of sleep apnea in children
- Poor school performance
- Slowness, drowsiness at school misunderstood as laziness
- Breathe through the mouth
- Not wanting to go to bed. It can be said that the brain "takes away their sleep" because they know that sleeping leaves the amount of O2 needed in their body.
- Unusual positions for sleeping, such as sleeping on the hands and knees, or with the neck hyperextended
- Beds very undone in the morning
- They sleep in the car from school to home
- Disorders of learning and behavior
- Waking up at night even for a moment, the brain wakes them up to change their posture
- Getting up to pee for the same reason
Symptoms of sleep apnea in adults
- Uneasy and not restful sleep; nightmares, insomnia
- Waking up to go to the bathroom, feeling suffocated
- Night sweats
- Drowsiness, irritability, forgetfulness
- Dry mouth
- Lack of attention during the day
- Sexual dysfunction
- Muscle and joint pains that are confused with fibromyalgia
Consequences of sleep apnea
- Accidents, whether cars, boats, trains, etc.. According to some surveys, apnea is behind 60% of car accidents, as the driver falls asleep. Roads and cars are getting better, that is, they are becoming increasingly monotonous and induce drowsiness. In fact, there are several countries in which for the renewal of the driving license it is necessary to present a medical certificate of a polysomnography, demonstrating that you have apnea.
- Apnea is behind myocardial infarctions, strokes. If we think for a moment about how many young people have suddenly died of a heart attack or a stroke without apparent cause, completely healthy, now it is showing that there was a sleep apnea behind it.
- Alterations in family relationships with decrease in quantity and quality since these people have symptoms of depression and fatigue, to which muscular and joint pains are added that reduce their relationship life to a minimum, isolating them progressively with repercussion also of their life in couple.
- The risk of diabetes and metabolic disorders are greater
During the day the brain directs our life and uses the night to make the hormones that we use during the day. The lack of O2 during the night in children prevents it from growing normally. The growth hormone stops producing in a normal amount, so an urgent diagnosis and treatment in these children is almost "vital".
The sad consequences that they have to endure as a lazy person, apathetic, not athletic, unrelated to their friends ..... A sad childhood! For a lack of diagnosis.
Many times because of a blindfold in the eyes of parents who do not perform the necessary tests. They do not see it as appropriate because the child wakes up before, does not sleep at bedtime, does not believe they are sick just by falling asleep on the bus back from school, moving in bed, sweating ...... Until they reach higher courses that teachers warn of their "laziness" they do not start up having prevented for years the adequate synthesis of the growth hormone with its irreversible consequences.
Treatment of sleep apnea
In children, the orthodontist treats mandibular reduction and maxillary compression, for which early diagnosis is essential. The expansion devices of the maxilla and / or functional apparatus stimulate mandibular sagittal growth.
We recently handled mandibular distractors that, after a small surgery, are placed for about a month and stimulate mandibular growth to achieve normal size.
On the other hand, the otorrino removes or diminishes the size of tonsils and vegetations as an essential treatment if there is an obstructive hypertrophy
In adults the treatments are different since the factors that produce them are different:
- Orthognathic surgery is the only thing that cures sleep apnea. It is performed as a team with the orthodontist and the maxillofacial surgeon. This surgery increases VA by restoring normal or even larger size and preventing physiological decline after 50 years. It offers a normal life without any of the following devices and allows to forget about the problem and the disease, something that none of the following treatment achieves, are palliative alone.
Although you have to take orthodontic treatment and overcome the fear or respect to accept a surgical treatment, given the very good results, the number of patients who decide to submit increases annually considerably.
- A CPAP is a device that injects air under pressure through a mask, restoring the lack of air that stops entering the lungs due to the nocturnal decrease of the VA. . . . .