IN THE STRUCTURAL DEVELOPMENT OF THE UPPER AIRWAY
EPIGENETIC FACTORS
O bstructive sleep apnea ( OSA ) is a common disorder , which is characterized by repetitive collapse of the upper airway during sleep . Upper airway narrowing and sleep-induced loss of muscle tone are important factors in the development of OSA . However , there is a growing recognition that craniofacial abnormalities also commonly occur in patients with OSA . In addition , clinical and epidemiological studies show that OSA is a multifactorial and complex disease with a strong genetic basis .
It has been estimated that approximately 40 % of the variance in the apnea hypopnea index ( AHI ) may be explained by familial factors . It is also likely that genetic factors associated with craniofacial structure , body fat distribution and neural control of the upper airway muscles interact to produce the OSA phenotype . Indeed , it is thought that there is a continuous interaction between genetic and epigenetic factors in the structural development of the upper airway .
IN THE STRUCTURAL DEVELOPMENT OF THE UPPER AIRWAY
Currently , it is believed that continuous positive airway pressure ( CPAP ) and surgical bimaxillary advancement procedures represent curative options for OSA . However , mandibular advancement devices ( MADs ) are favored by dental professionals for the management of OSA , in conjunction with their medical sleep specialist colleagues . But , the approach taken by most MADs is geared towards symptomatic relief with little attention being paid to the underlying etiology of the condition .
While MADs are undoubtedly successful in the short- to midterm in the clinical management of OSA , unwanted long-term side effects of MADs , such as disruption of the occlusion and temporo-mandibular joint pain , have been reported .
In contrast , preliminary data has shown that biomimetic oral appliance therapy can reduce the AHI to < 5 in adults diagnosed with moderate to severe OSA ( AHI < 29 ), and sometimes virtually eliminate it even in severe cases
DAVE SINGH , DDSC , PHD , DMD
Dr Dave Singh , DDSc , PhD , DMD
with an AHI > 30 . However , large scale studies by independent researchers are still required to reproduce these results to confirm the efficacy of this exciting new approach .
Moreover , the application of pediatric epigenetics embraces a firm promise in the prevention of sleep disordered breathing in young children .
Join me as I delve further into this topic at the North American Dental Sleep Medicine Symposium in Clearwater on February 17th – 18th .
COME SEE ME AT THE NORTH AMERICAN DENTAL SLEEP MEDICINE SYMPOSIUM AS I DISCUSS PNEUMOPEDICS : NON- SURGICAL UPPER AIRWAY REMODELING