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Ronald Attanasio. Dental Management of Sleep Disorders
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Dental Management of Sleep Disorders
Dedication
List of Contributors
Preface
Section 1 Overview of Sleep Medicine
1 Impact of Sleep Disorders on Society. Conceptual Overview
The Evolution of Sleep in Modern Times
Epidemiology and Prevalence of Sleep Disorders
Prevalence of Sleep Apnea
Prevalence of Insomnia
Prevalence of Restless Leg Syndrome (RLS)
Increasing Awareness of Narcolepsy
Risk Factors
Health Consequences and Related Costs
The Dental Perspective
Conclusion
References
2 Human Sleep. Conceptual Overview
Normal Sleep
Stages of Sleep
NREM Sleep
Stage N1
Stage N2
Stage N3
REM Sleep (Stage R)
Cycles and Hours of Sleep
Neurobiology of Sleep
Neurotransmitters of Wakefulness and Sleep
Neurotransmitters of Arousal/Wakefulness
Dopamine (DA)
Norepinephrine (NE)
Serotonin (5HT)
Acetylcholine (ACH)
Histamine (HA)
Other Neurotransmitters of Arousal and Wakefulness. Orexin/Hypocretin
Glutamate
Cortisol
Neurotransmitters for Sleep
GABA (Gamma‐Aminobutyric Acid or γ‐Aminobutyric Acid)
Adenosine
Glycine
Serotonin (5HT)
The Role of Melatonin
Flip‐Flop Switch
The Circadian Rhythm
The Gut Microbiome
Conclusion
References
3 Pathophysiology of Sleep‐Related Breathing Disorders. Conceptual Overview
Normal Respiration
Anatomy and Function of the Airway
Soft Palate
Oropharynx
The Hyoid
The Hypopharynx
In Summary
Nerve Supply to the Muscles of the Airway
Basics of Airway Dynamics
Conclusion
References
4 The Classification of Sleep Disorders. Conceptual Overview
Classification Systems
Diagnostic Classification of Sleep and Arousal Disorders (DCSAD)
International Classification of Disease (ICD‐10)
Diagnostic and Statistical Manual of Mental Disorders (DSM)
The International Classification of Sleep Disorders (ICSD)
General Categories
Insomnia
Sleep‐Related Breathing Disorders (SRBDs)
Central Disorders of Hypersomnolence
Circadian Rhythm Sleep–Wake Disorders
Parasomnias
REM‐Related Parasomnias
Other Parasomnias
Sleep‐Related Movement Disorders
Appendix A: Sleep‐Related Medical and Neurological Disorders
Appendix B: Coding for Substance‐Induced Sleep Disorders
Conclusion
References
5 The Relationship Between Sleep Disorders, Medical Conditions, and Your Health. Conceptual Overview
Health Consequences Associated with Sleep Disorders
Obesity
Hypertension
Cardiovascular Disease
Arrhythmias
Atrial Fibrillation (AFib)
Atherosclerosis, Endothelial Dysfunction, and Coronary Artery Disease
Congestive Heart Failure
Cerebrovascular Function and Stroke
Oxidative Stress
Triglycerides and Cholesterol
Diabetes Type 2
Gastroesophageal Reflux Disease (GERD)
Asthma
Hypothyroidism and Hyperthyroidism
Neurodegenerative Disorders
Cancer and Sleep Disorders
Other Areas to Consider. The Gut Microbiota
Sleep Duration
Periodontal Disease
Pregnancy
Motor Vehicle Accidents
Pain and Sleep
Conclusion
References
6 Medications and Sleep. Conceptual Overview
Medications for Sleep Disorders
The Benzodiazepine Receptor Agonists (BZRAs)
Orexin (Hypocretin) Receptor Antagonists
Benzodiazepines (BDZs) and Related Sedatives
Melatonin/Derivatives (Melatonin Receptor Agonists)
Other Medications that May Impact Sleep
Anticonvulsant Medications
Over‐the‐Counter (OTC) Sleep Aids
Nutritional and Herbal Supplements
Medications That May Interfere with Sleep
Cardiovascular Medications
Antidepressants
Corticosteroids
Stimulants
Other Considerations
Nicotine
Alcohol
Opioids
Anti‐inflammatory Medications (NASIDs)
Marijuana/cannabinoids
Conclusion
References
Section 2 Dentistry and Sleep Medicine
7 Dental and Orofacial Consequences of Sleep‐Related Breathing Disorders. Conceptual Overview
Dental Conditions and Consequences Associated with Sleep‐Related Breathing Disorders
Tooth Wear
Tooth Mobility
Periodontal Disease
Tooth Loss
Tooth and/or Restoration Fracture
Implant Failure
Bruxism and Its Relationship to Sleep‐Related Breathing Disorders
Relationship Between Sleep and Pain
Epidemiology of Orofacial Pain and Sleep
Neuroanatomy and Functional Changes
Neurochemical Involvement and Influence
Sleep and Orofacial Pain Conditions
Neurovascular (Headache)
Migraine
Tension‐type Headache
Cluster Headache
Other Headaches of Interest
Neuralgia
Neuropathy
Posttraumatic
Burning Mouth Syndrome
Temporomandibular Disorders (TMDs)
Myofascial Muscle Pain
Temporomandibular Joint (TMJ)
Conclusion
References
8 Pediatrics and Adolescent Sleep and Sleep Disorders. Conceptual Overview
Prevalence of Sleep Disorders in the Pediatric and Adolescent Population
Recognition of Sleep Disorders in Children and Adolescents
Sleep‐Related Breathing Disorders (SRBDs)
Sleep Studies in Children
Clinical Findings
Consequences of Sleep Disruption
Other Sleep Disorders of Interest. Insomnia
Restless Legs Syndrome (RLS)
Narcolepsy
Management Strategies
First Step Is Recognition
Management Options
Tonsillectomy and Adenoidectomy
Dental and Orthodontic Treatment
Additional Subjects to Consider. Behavioral Considerations
Adjunctive Considerations
Conclusion
References
9 Role of the Dentist in Sleep Medicine. Conceptual Overview
Historical Role of the Dentist in Sleep Medicine
The Role of the Dentist in Sleep Medicine
Sleep Medicine Education in Dental Schools
Developing Relationships with Physicians
The Critical Next Step(s)
Steps to Improve Relationships with Physicians
Conclusion
References
10 Other Sleep Disorders of Importance. Conceptual Overview
Insomnia
Narcolepsy
Central Disorders of Hypersomnolence
Circadian Rhythm Disorders
Parasomnias
Sleep‐Related Movement Disorders
Appendix A and B
Conclusion
References
11 Practicing Dental Sleep Medicine. Conceptual Overview
Becoming Involved
Limited Involvement
Comprehensive Involvement
Proper Steps for Involvement
Education
Staff Involvement
Develop a Comfort Level and Improve Competence
Marketing
Telehealth
Billing and Insurance Processes
Conclusion
References
Section 3 Assessment for Sleep‐Related Breathing Disorders
12 Screening for Sleep Disorders. Conceptual Overview
Basic Questions
Questionnaires for Screening
The Epworth Sleepiness Scale
STOP‐Bang
The Berlin Questionnaire
Summary
Other Types of Screening
Nasal Airway Screening
Pittsburgh Sleep Quality Index (PSQI)
Screening for Risk of Sleep Apnea in Pregnancy
Screening for Insomnia
Quality of Life Survey
Pediatric and Adolescent Questionnaires
Bears Questionnaire
Other Questionnaires to Consider
Conclusion
References
13 The Clinical Evaluation by the Dentist. Conceptual Overview
What the Dentist Sees That May Indicate the Risk for an SBD
The Clinical Evaluation for the SRBD
The History
Review of the Medical History
Review of Current Medications
SRBD Evaluation
Temporomandibular Disorders
TMJ Evaluation
Muscle Tenderness of the Head and Neck
The Dentition and Oral Airway Evaluation
Dental and Oral Evaluation
The Importance of the Lip Seal
The Tongue
Airway Evaluation
The Uvula
The Soft Plate
The Gag Reflex
The Tonsils
Oropharyngeal/Palatopharyngeal Width
The Nasal Airway Evaluation
Nasal Airway Anatomy
Nasal Airway Testing
Subjective Airway Testing
Management Planning
Conclusion
References
14 Imaging for Sleep‐Related Breathing Disorders. Conceptual Overview
Imaging in the Dental Office for Sleep‐Related Breathing Disorders
Disorders and Mandibular Repositioning
Panoramic Radiography
Cephalometric Radiography
Cone Beam Computed Tomography
Conclusion
References
15 The Polysomnogram. Conceptual Overview
Levels of Testing for a Sleep Disorder
Guidelines for the PSG
Daytime Sleep Studies
Multiple Sleep Latency Test
Maintenance of Wakefulness Test
Conclusion
References
16 Ambulatory Sleep Testing. Conceptual Overview
Level III Home Sleep Apnea Testing (HSAT)
Advantages of HSAT
Disadvantages of HSAT
Use of HSAT by the Dentist
Follow‐up Testing
Level IV Studies
Conclusion
References
Section 4. Oral Appliance Therapy for Sleep‐Related Breathing Disorders
17 Oral Appliance Therapy for the Management of Sleep‐Related Breathing Disorders. Conceptual Overview
A Brief History of Oral Appliances
Indications and Contraindications for Oral Appliance Therapy
Basic Function of Oral Appliances
Design Characteristics of Oral Appliances
Adjustable
Posterior Support
Titration (Also Known As Calibration)
Full Tooth Coverage
Mandibular (Jaw) Mobility
Lip Seal and Patent Nasal Airway
Maximum Tongue Space
Effectiveness and Current Status of Oral Appliances
Effectiveness of OAT Relative to PAP Therapy
Effect of OAT on Cardiovascular Disease
Effect of OAT on Oxidative Stress
OAT and Positional Therapy
OAT Related to Surgery
Predicting the Effectiveness of Oral Appliance Therapy
Precision Medicine
Phenotyping and Endotyping
Current Status of Oral Appliances
Trial Oral Appliances
Combination Oral Appliance and PAP Therapy
Laboratory Fabrication of Oral Appliances
Conclusion
References
18 Fabrication and Delivery of the Oral Appliance. Conceptual Overview
The Impression Process
Interocclusal Record – The Therapeutic Bite Registration
3D Digital Scanners
DISE (Drug‐Induced Sleep Endoscopy)
Delivery of the Oral Appliance
Patient Instructions
Informed Consent
Conclusion
References
19 Follow‐up Care and Titration in Oral Appliance Therapy. Conceptual Overview
Follow‐up Care
Follow‐up Protocol
Adjust the Oral Appliance
Assess the Symptoms
Look for Adverse (Side) Effects
Review the Plan
Titration of the Oral Appliance
Assessing for Efficacy
Neurocognitive Improvement. Epworth Sleepiness Scale
Mood and Memory
Cardiovascular Improvement
Quality of Life
Ambulatory Follow‐up Assessment and Testing
Conclusion
References
20 Adverse Effects and Their Management in Oral Appliance Therapy. Conceptual Overview
Adverse Effects and Their Management
Common Adverse Effects and Potential Management
Excessive Salivation
Face, Jaw, and TMD Discomfort
Occlusal (Bite) Changes
Opening of Interproximal Contacts
Other Less Common Adverse Effects
Conclusion
References
Section 5. Other Management Strategies for Sleep‐Related Breathing Disorders
21 Positive Airway Pressure Therapy. Conceptual Overview
Historical Overview
Types of PAP Therapy
CPAP
Bilevel PAP (BPAP)
Expiratory Pressure Relief System
Auto‐adjustable PAP (APAP)
Indications for PAP Therapy
Mechanisms of Action
PAP Interface Options
Determination of PAP Pressure Levels
Other Considerations Associated with PAP Use
Humidification
Ramp
Traveling with PAP Devices
Supplemental Oxygen
Adverse (Side) Effects of PAP
Patient Adherence and Compliance
Benefits of PAP Therapy
Combination Therapy
Conclusion
References
22 Surgical Management for Sleep‐Related Breathing Disorders. Conceptual Overview
Indications and Contraindications for Surgical Intervention
Presurgical Evaluation
Types of Surgery
Tracheostomy
Uvulopalatolpharyngoplasty (UPPP) and Laser‐Assisted Uvulopalatoplasty (LAUP)
Nasal Surgery (Focus on Turbinate Reduction, Septoplasty, Polyp Removal)
Soft Palate Implants (Pillar Procedure)
Tongue Surgery
Multilevel Management
Maxillomandibular Advancement Surgery (MMA)
Hypoglossal Nerve Stimulation (HNS)
Other Surgical Procedures. Tonsillectomy and Adenoidectomy (T&A)
Bariatric Surgery
Others Less Well‐Known Surgeries
Conclusion
References
23 Alternative and Adjunctive Options for the Management of Sleep Disorders. Conceptual Overview
Alternative Therapies
Weight Loss
Address the Nasal Airway and Nasal Breathing
Myofunctional/Oropharyngeal Exercises
Positional Therapy
Alternative Therapies to Consider
Exercises
Pharmacological Therapy
Use of Supplemental Oxygen
Pillows
Physical Exercise
Cognitive Behavioral Therapy for Insomnia (CBT‐I)
Conclusion
References
Appendix A Abbreviations in Sleep Medicine. Conceptual Overview
List of Abbreviations
Appendix B Glossary of Terms in Sleep Medicine
Appendix C Sample Patient Screening Questionnaires
Epworth Sleepiness Scale
Berlin Questionnaire
STOP‐Bang Questionnaire
NOSE Scale (nasal obstruction symptom evaluation)
Pittsburgh Sleep Quality Index (PSQI)
Insomnia Risk Questionnaire
Dental Sleep Medicine (DSM) Quality of Life Survey
References
Appendix D Sample Evaluation Format for SRBD and Airway Clinical Evaluation. Introduction
TMD Evaluation. TMJ Evaluation (Check the box that applies – circle R or L side)
Myofascial (Muscle) Evaluation – Head and Neck
Dental and Oral Evaluation
Tongue Evaluation
Airway Evaluation
The Nasal Airway Evaluation
Airway Testing to Assess Starting Position
Management Plan – Future Options
Index. a
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