Snoring and mouth opening/breathing during sleep can be signs of severe sleep apnea

Obstructive Sleep Apnea (OSA) is a serious and increasingly recognized condition that not only impacts sleep quality but also has long-term effects on various body systems, including the nervous, cardiovascular, and endocrine systems, and can lead to stroke. The symptoms and risks associated with OSA include:

1. 1. Daytime Fatigue: Frequent awakenings due to sleep apnea prevent deep sleep, leading to daytime drowsiness, fatigue, and irritability.
2. 2. Difficulty Concentrating: OSA sufferers may struggle to focus and find themselves dozing off during activities like work, watching TV, or even driving. This condition increases the risk of traffic and workplace accidents.
3. 3. Mood Changes: You may experience irritability, mood swings, or depression. Children and teenagers with OSA may perform poorly in school or exhibit behavioral problems.
4. 4. High Blood Pressure and Heart Problems: The sudden drops in blood oxygen levels during OSA episodes can increase blood pressure and strain the cardiovascular system, raising the risk of hypertension (high blood pressure).
5. 5. Increased Risk of Heart Attack, Stroke, and Arrhythmias: OSA can elevate the risk of recurring heart attacks, stroke, and irregular heartbeats, such as atrial fibrillation. For those with heart disease, multiple episodes of low oxygen (hypoxemia) during sleep can lead to sudden death due to irregular heart rhythms.
6. 6. Type 2 Diabetes: OSA raises the risk of developing insulin resistance and type 2 diabetes.
7. 7. Metabolic Syndrome: This condition, which includes high blood pressure, abnormal cholesterol levels, high blood sugar, and increased waist circumference, is associated with a higher risk of heart disease.
8. 8. Complications with Medication and Surgery: OSA can pose risks with certain medications and general anesthesia. Individuals with OSA are more likely to experience complications after major surgery due to respiratory issues, particularly when under anesthesia and lying on their back. It is crucial to inform your doctor about your OSA and treatment before any surgery.
9. 9. Liver Problems: People with OSA are more likely to have abnormal liver function test results, and their livers may show signs of scarring, known as nonalcoholic fatty liver disease.
10. 10. Sleep Deprivation for Partners: Loud snoring can disturb the sleep of anyone nearby, often forcing them to sleep in another room or even on a different floor to get enough rest.

While OSA is primarily a respiratory disorder, the role of dental professionals is crucial in treatment plans. However, in Vietnam, this aspect is often overlooked, with treatment primarily focusing on CPAP machines or ENT care. In contrast, globally, there is a specialized field called "Dental Sleep Medicine" dedicated to treating sleep disorders through dental interventions.

Dental treatment is highly effective for cases where anatomical issues, such as a narrow jaw or severe jaw misalignment, restrict the airway.

Below is an example of a 23-year-old male patient who sought treatment for severe snoring, high blood pressure, and frequent difficulty concentrating. After undergoing a polysomnography (PSG) test, the patient was diagnosed with severe OSA, with an apnea-hypopnea index (AHI) of 62.8 (>30), meaning he experienced 62.8 apnea/hypopnea episodes per hour of sleep. The patient had a Class II skeletal pattern with significant mandibular retrusion and a severely narrow airway on 3D imaging. The patient did not want to rely on a CPAP machine for a whole life and he wanted to improve his sleep apnea, chewing function, and aesthetics.

The location of the airway constriction causing obstruction before treatment.

A surgical plan for bimaxillary advancement (rotation MMA) was developed and executed by Dr. Nguyen Truong Minh (Hanoi Medical University Hospital) to advance the lower jaw by approximately 12 mm and the chin by 19 mm, improving both bite function and aesthetics. Postoperative results were very satisfactory, with significant improvements in aesthetics and sleep quality. More importantly, the patient's airway was notably widened, and one year after surgery, his PSG results showed no signs of sleep apnea, with an AHI of 3.1 (<5).

Profile of the patient before and after surgery.

Significant airway expansion post-surgery, before-and-after comparison.

This case demonstrates that with the correct diagnosis, plan, and execution, treatment outcomes can be excellent, achieving the goals of curing sleep apnea, correcting bite issues, and enhancing facial aesthetics.

Dental professionals play a very important role in less invasive treatments, using orthodontic devices that guide proper jaw development in young children and bring mandibulars forward to extend the airway in adults. Dental treatment is highly significant for young patients, as addressing respiratory abnormalities early and treat them is crucial for the children’s normal development.