Dental Management of Sleep Disorders. Ronald Attanasio. Читать онлайн. Newlib. NEWLIB.NET

Автор: Ronald Attanasio
Издательство: John Wiley & Sons Limited
Серия:
Жанр произведения: Медицина
Год издания: 0
isbn: 9781119014621
Скачать книгу
Increases with age Worsens over time – follows a chronic course Females greater than males Use of antidepressants Associated with low iron levels Peripheral neuropathy Pregnancy End‐stage renal disease May coexist with sleep bruxism

      Source: Adapted from Foley et al. [21].

Prevalence of sleep problems by % Number of comorbidities
36% None
52% 1–3
69% 4 or more

      Because of the increased risk for the development of health problems with sleep disorders, there may be an associated increase in healthcare costs as well. It is well documented that the presence of a sleep disorder may drive up the cost of healthcare in general. It has been estimated that untreated sleep apnea may add $3.4 billion in medical costs [25]. At this time, it is unclear what the actual savings in medical costs are with the management of sleep apnea. In a study of 31 patients diagnosed with CVD and who had sleep apnea, when they adequately managed the apnea there was a reduction in the need for hospitalization related to the cardiovascular illness [26]. In addition, it is recognized that an association with the severity of the sleep disorder may be related to increased healthcare expenditures.

      The costs of healthcare are increased by the lack of attention to the specific sleep disorder. A 1998 study demonstrates that 10 years prior to the actual diagnosis of sleep apnea the patients that were eventually diagnosed with sleep apnea when compared to the matched controls incurred nearly double the costs for healthcare and were hospitalized more [27, 28]. This demonstrates that in many instances the sleep disorder precedes the onset of the specific health issue or consequence. If the sleep disorder is not discovered, then the attention to the related health issue takes precedence. This may then lead to an increase in expenditures for various testing, imaging, physician visits, hospitalizations, and medication or prescription usage.

      Along with the health issues that may arise there is also an impact on one's QOL. Studies that look at QOL measures clearly demonstrate that patients with a sleep disorder feel that their QOL is poorer than those without apnea [29, 30]. In addition, the QOL of the bed partner is also impacted. When the SRBD is improved, both the patient and the bed partner may experience an improvement in their QOL [31].

      The Dental Perspective

Painful conditions Headaches
Arthritis Fibromyalgia
Anxiety or depression Hyperthyroidism/hypothyroidism
Pregnancy Gastroesophageal reflux disease (GERD) or acid reflux
Medication usage Cardiovascular disease
Hypertension Diabetes
Obesity Periodontal disease

      Regardless of the role the dentist assumes, the initial action needs to start with the recognition of those who may be at risk for or have a health problem that may have an underlying sleep disorder as a contributing factor. Having an awareness of these relationships has the potential to be beneficial to the overall health of people and to improve their QOL.

      The dentist now has an increasing role in the recognition of a patient who may be at risk for a sleep disorder, especially those that are most commonly encountered. This has been supported and emphasized by the American Dental Association (ADA) in a number of ways but specifically related to the recognition and management of SRBD [34, 35]. In 2019, the ADA published a guide for the dentist regarding screening for diabetes by assessing blood glucose and A1c [36]. This is an additional means by which the dentist is able to contribute to the overall health of the patient, similar to screening for hypertension. Once the condition is recognized the appropriate referral for more definitive management is indicated. Epidemiologic data supports the increasing awareness of the relationship of sleep disorders and other health issues. Clinical management and decision‐making now emphasize sound evidence‐based documentation that relies on epidemiologic studies to assist in determining the coexistence of a sleep disorder that in turn are impacting the health of the public and the patients we serve.

      1 1 Kryger, M.H., Roth, T., and Dement, W.C. (2005). Normal human sleep: an overview. In: Principles and Practice of Sleep Medicine, 13. Elsevier Saunders.

      2 2 Lee‐Chiong, T.L. (2006). SLEEP: A Comprehensive Handbook, 1e. Wiley‐Liss/Wiley.

      3 3 Ekirch, A.R. (2005). At Day's Close: Night in Times Past. W. W. Norton: New York.

      4 4 Reiss, B. (2017). Wild Nights How Taming Sleep Created Our Restless World. New York: Basic Books.

      5 5 Frérot, M., Lefebvre, A., Aho, S. et al. (2018). What is epidemiology? Changing definitions of epidemiology 1978‐2017. PloS ONE 13 (12): e0208442.

      6 6 Macmahon, B. and Pugh, T.F. (1970). Epidemiology: Principles & Methods. Boston: Little, Brown and Co.

      7 7 Kryger,