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CC BY-NC-ND 4.0 · Sleep Sci 2018; 11(02): 112-117
DOI: 10.5935/1984-0063.20180021
ORIGINAL ARTICLE

Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college - A cross sectional study

Sonal Sadashiv Kale
1   Dr. D.Y. Patil Vidyapeeth, Dr. D.Y Patil Dental College and Hospital, Department of Public Health Dentistry - Pune - Maharashtra - India.
,
Pradnya Kakodkar
1   Dr. D.Y. Patil Vidyapeeth, Dr. D.Y Patil Dental College and Hospital, Department of Public Health Dentistry - Pune - Maharashtra - India.
,
Sahana Hegde Shetiya
1   Dr. D.Y. Patil Vidyapeeth, Dr. D.Y Patil Dental College and Hospital, Department of Public Health Dentistry - Pune - Maharashtra - India.
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Objectives

To assess the oral findings of patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to outpatient department of a dental college. Methods: Patients coming to dental Out Patient Department (OPD) were screened using STOP questionnaire and were categorized into high (n=130) and no risk (n=130) OSA groups. BANG (body mass index, age, neck circumference and gender) was recorded for both the OSA risk group patients. Following this oral and general examination was performed using predetermined criteria for temporomandibular disorder (TMD), Angle’s Class of Malocclusion, maxillary arch constriction, facial profile, Mallampati score for uvula, tongue size, depth of palatal vault and periodontitis. Chi-squared statistics was applied to know the significant difference among the two groups. Multivariate logistic regression model was run by including the significant variables. Results: 94 females and 166 males were present in the study with a mean age of 43.67±11.89 in both the risk groups. All the variables except Angle’s class of malocclusion and periodontitis showed significant difference among high and no risk OSA groups. Logistic regression confirmed that neck circumference, Class 3 or 4 Mallampati score, large tongue and deep palatal vault were commonly observed among high risk OSA group and were independent risk factors for developing high risk of OSA. Conclusion: Neck circumference>40cm, large tongue, Class 3 or 4 Mallampati score and deep palatal vault were found to be independent predictors of developing high risk of OSA. Dentist can play a vital role in screening such patients as he comes in close vicinity of oral cavity and thus can refer the patients to sleep physician to promote interdisciplinary approach.

Obstructive Sleep Apnea - Risk Factors - Diagnosis, Oral - Surveys and Questionnaires - Dentists


Publication History

Received: 29 January 2018

Accepted: 21 May 2018

Article published online:
13 October 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • REFERENCES

  • 1 Huynh NT, Emami E, Helman JI, Chervin RD. Interactions between sleep disorders and oral diseases. Oral Dis. 2014;20(3):236-45.
  • 2 Arora SA, Kochhar R, Narang S, Saurav K. Sleep Related Breathing Disorders: What & Why A Dentist Should Know? An Overview of Dental Sleep Medicine. Natl J Integr Res Med. 2015;6(5):94-102
  • 3 Charkhandeh S. Dental Sleep Medicine- Past, Present, Future. Continuum [Internet]. 2013; [cited 2017 Sep 23] 26(3):4-8 cited 2017 Sep 23]. Available from: https://www.aurumgroup.com/assets/Uploads/Continuum/ Vol-26-issue-3.pdf
  • 4 McNicholas WT. Clinical diagnosis and assessment of obstructive sleep apnoea syndrome. Monaldi Arch Chest Dis. 1997;52(1):37-42.
  • 5 McNicholas WT. Diagnostic criteria for the sleep apnoea syndrome: time for consensus. Eur Respir J. 1996;9(4):634-35.
  • 6 Sanders AE, Essick GK, Fillingim R, Knott C, Ohrbach R, Greenspan JD, et al. Sleep apnea symptoms and risk of temporomandibular disorder: OPPERA cohort. J Dent Res. 2013;92(7 Suppl):70S-7S.
  • 7 Lattimore JL, Celermajer DS, Wilcox I. Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol. 2003:41(9):1429-37.
  • 8 Lanfranchi P, Somers VK. Obstructive sleep apnea and vascular disease. Respir Res. 2001;2(6):315-9.
  • 9 Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep.disordered breathing and hypertension. N Engl J Med. 2000;342(19):1378.84.
  • 10 Nayak R, D’souza B, Kotrashetti VS, Somannavar P. Correlation and comparison of body mass index and oral health status among urban South Indian population: A pilot study. Int J Med Public Health. 2015;5(2):184-8.
  • 11 Kumar P, Mastan K, Chowdhary R, Shanmugam K. Oral manifestations in hypertensive patients: A clinical study. J Oral Maxillofac Pathol. 2012;16(2):215-21.
  • 12 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med. 2017;13(3):479-504.
  • 13 Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to diagnosis and treatment of patients with suspected sleep apnea. Am J Respir Crit Care Med. 2004;169(6):668-72.
  • 14 Luo J, Huang R, Zhong X, Xiao Y, Zhou J. STOP-Bang questionnaire is superior to Epworth sleepiness scales, Berlin questionnaire, and STOP questionnaire in screening obstructive sleep apnea hypopnea syndrome patients. Chin Med J (Engl). 2014;127(17):3065-70.
  • 15 Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1(1):21-32.
  • 16 Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108(5):812-21.
  • 17 Bhalajhi SI. Orthodontic diagnosis. In: Bhalajhi SI. Textbook of Orthodontics- The Art and Science. 4th ed. New Delhi: Arya; 2009. p. 129-58.
  • 18 Rodrigues MM, Dibbern RS, Goulart CW. Nasal obstruction and high Mallampati score as risk factors for Obstructive Sleep Apnea. Braz J Otorhinolaryngol. 2010;76(5):596-9.
  • 19 Weiss TM, Atanasov S, Calhoun KH. The association of tongue scalloping with obstructive sleep apnea and related sleep pathology. Otolaryngol Head Neck Surg. 2005;133(6):966-71.
  • 20 Indian Dental Academy [Internet]. Model analysis 1 /certified fixed orthodontic courses. [cited 2017 Sep 28]. Available from: https://www. slideshare.net/indiandentalacademy/model-analysis-1
  • 21 Ruangsri S, Jorns TP, Puasiri S, Luecha T, Chaithap C, Sawanyawisuth K. Which oropharyngeal factors are significant risk factors for obstructive sleep apnea? An age-matched study and dentist perspectives. Nat Sci Sleep. 2016;8:215-9.
  • 22 World Health Organization (WHO). Oral Health Surveys: Basic Methods. 5th ed. Geneva: WHO; 2013.
  • 23 Ahmad NE, Sanders AE, Sheats R, Brame JL, Essick GK. Obstructive sleep apnea in association with periodontitis: a case-control study. J Dent Hyg. 2013;87(4):188-99.
  • 24 Sutherland K, Lee RW, Cistulli PA. Obesity and craniofacial structure as risk factors for obstructive sleep apnoea: impact of ethnicity. Respirology. 2012;17(2):213-22.
  • 25 Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29(7):903-8.
  • 26 Sharma SK, Kumpawat S, Banga A, Goel A. Prevalence and risk factors of obstructive sleep apnea syndrome in a population of Delhi, India. Chest. 2006;130(1):149-56.
  • 27 Al-Madani GH, Banabilh SM, El-Sakhawy MM. Prevalence of snoring and facial profile type, malocclusion class and dental arch morphology among snorer and nonsnorer university population. J Orthod Sci. 2015;4(4):108-12.
  • 28 Schellenberg JB, Maislin G, Schwab RJ. Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med. 2000;162(2 Pt 1):740-8.
  • 29 Balasubramaniam R, Klasser GD, Cistulli PA, Lavigne GJ. The Link between Sleep Bruxism, Sleep Disordered Breathing and Temporomandibular Disorders: An Evidence-based Review. J Dent Sleep Med. 2014;1(1):27-37.
  • 30 Cunali PA, Almeida FR, Santos CD, Valdrighi NY, Nascimento LS, Dal’Fabbro C, et al. Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy. J Orofac Pain. 2009;23(4):339-44.
  • 31 Triplett WW, Lund BA, Westbrook PR, Olsen KD. Obstructive sleep apnea syndrome in patients with class II malocclusion. Mayo Clin Proc. 1989;64(6):644-52.
  • 32 Banabilh SM, Samsudin AR, Suzina AH, Dinsuhaimi S. Facial profile shape, malocclusion and palatal morphology in Malay obstructive sleep apnea patients. Angle Orthod. 2010;80(1):37-42.
  • 33 Seto BH, Gotsopoulos H, Sims MR, Cistulli PA. Maxillary morphology in obstructive sleep apnoea syndrome. Eur J Orthod. 2001;23(6):703-14.
  • 34 Banabilh SM, Suzina AH, Dinsuhaimi S, Samsudin AR, Singh GD. Dental arch morphology in south-east Asian adults with obstructive sleep apnoea: geometric morphometrics. J Oral Rehabil. 2009;36(3):184-92.
  • 35 Petrou-Amerikanou C, Belazi MA, Daskalopoulou E, Vlachoyiannis E, Daniilidou NV, Papanayiotou PC. Oral findings in patients with obstructive sleep apnea syndrome. Quintessence Int. 2005;36(4):293-8.
  • 36 Lam B, Ip MS, Tench E, Ryan CF. Craniofacial profile in Asian and white subjects with obstructive sleep apnoea. Thorax. 2005;60(6):504-10.
  • 37 Loke W, Girvan T, Ingmundson P, Verrett R, Schoolfield J, Mealey BL. Investigating the association between obstructive sleep apnea and periodontitis. J Periodontol. 2015;86(2):232-43.
  • 38 Famili P. Obstructive Sleep Apnea and Periodontal Disease: Review of Established Relationships and Systematic Review of the Literature. J Dent Oral Health. 2015;1(4):1-4.
  • 39 Huynh NT, Morton PD, Rompré PH, Papadakis A, Remise C. Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations. Am J Orthod Dentofacial Orthop. 2011;140(6):762-70.