Dental Sleep Medicine and NICE guidelines Professor Ama Johal

orthodontics In summary

Join me for a summary looking at Dental Sleep Medicine and NICE guidelines. This summary describes obstructive sleep apnoea and the new guidelines of its management. There is a focus on the Mandibular Advancement Splint and the occlusal outcomes for patients using this appliance. This lecture was given by Professor Ama Johal. Ama is a member of the advisory committee to NICE sleep apnoea/hypopnoea syndrome

Introduction

Obstructive sleep apnoea –

· Sleep related breathing disorder

· Poorly understood

· 70% collapse retroglossal area

· Stops breathing

· Body movement occurs – body tries to wake patient up as suffocating

o = disturbed sleep

Health consequences

· Day time sleepiness

· Hypertension, heart disease, stroke – all stroke patients screened for OSA

Treatment

· Severe / mod- gold standard Continuous positive airway pressure CPAP

o Filters air and pushes at high force

o To be effective 4-6 hours, 7 days a week – NOT curative

o Compliance / adherence 30%

NICE guidelines 2021

· Symptomatic receive CPAP

· if not comply then if a person Mandibular Advancement Splint

· Require good dental and periodontal health

· Age 18 +

MAS appliance

1. Anatomical – increase size of pharyngeal airway

a. Mandible move forwards, tongue advances with it

i. Post lingual - Best impact of patients who have tongue contribution to collapse 70% of patients

2. Reduces airway collapsibility

3. Physiological role – stimulate dilation of upper airway muscle – improving muscle strength and control

MAS appliance

semi customised Vs customised

Johal 2018 S/R

o Overall effects better with customised Vs semi customised

§ AHI 3

§ Daytime sleepiness 1

§ Self reported wear: 7 Vs 3 nights per week

§ Pt preference 95% prefer customised to semi-customised

Ideal design features customised Johal 2018

· Good retention - customised

· Semi adjustable – incremental advancement

o Allowing for further advancement and slow increase in airway

· Full occlusal coverage

· Minimal vertical opening

In high angle cases clockwise rotation of mandible – compresses post-palatal area and worsens airway IF increase vertical opening. Minimal occlusal opening prevents clockwise rotation

Follow up long term

· Unwanted occlusal change

o Mesial molar movement

o Reduction of OJ and OB approx. 1mm

o Proclination of 1mm lower incisors

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