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GURNEE, IL, August 17, 2009 /24-7PressRelease/ -- Sleep apnea and snoring are a major cause of numerous health care problems and have adverse effects on the quality of patients lives. Headaches, cardiac problems, high blood pressure, memory loss, uncontrolled diabetes, depression, fibromyalgia are a few of the problems related to sleep disordered breathing. The best way to evaluate sleep problems is unquestionably to have all night polysomnography or a sleep test at an accredited sleep center and to work with physicians board certified in sleep.
Unfortunately many patients with severe sleep disorders but who are not obese are not diagnosed or referred for sleep evaluation. The tongue may be an important telltale sign to alert physicians of problems. An article by Weiss TM, Atanasov S, Calhoun KH discusses the association of tongue scalloping with obstructive sleep apnea. According to the authors, "the finding of tongue scalloping is a useful clinical indicator of sleep pathology and that its presence should prompt the physician to inquire about snoring history." Physicians routinely look past the tongue to see the throat but in light of this information they should probably spend a little time looking at the tongue as well. This study was done at Southern Illinois University.
A recent study in Sleep by Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. evaluated the effectiveness of two types of oral appliances in treating sleep apnea. The MAS or mandibular advancement splint was compared to a TSD or tongue stabilizing device. The authors cited that patients clearly preferred the MAS device to the TSD. Compliance with treatment is an enormous issue and therefore patients preferences must be given a high priority.
The use of nasal CPAP for treating sleep apnea has long been considered the gold standard but years of studies have shown very low compliance. Studies have shown that only 23-45% of patients actually use their CPAP machines. An Interesting fact is that approximately 25% of patients love their CPAP machines from day one and continue to use it long term. Patients who initially are unsuccessful with CPAP rarely learn to love CPAP therapy but some manage to tolerate it especially if they work with a dedicated sleep lab. Other studies have shown that these patients who don't like CPAP initially average only 4-5 hours of nightly use not the 7-8 hours that is considered ideal.
When patients are offered a choice between nasal CPAP and Oral Appliances the majority prefer the comfortable oral appliances that have been approved as a first line of treatment of mild to moderate obstructive sleep apnea by the Parameters of Care of The American Academy of Sleep Medicine (AASM) and The American Academy of Dental Sleep Medicine. Oral appliances are also considered a second line of treatment for severe apnea when patients do not tolerate CPAP.
Dr Ira L Shapira is a Chicago Dentist who is a researcher and pioneer in Dental Sleep Medicine and who created http://www.ihatecpap.com to help patients who are CPAP intolerant find Dental Sleep Medicine Alternatives to CPAP. Dr Shapira emphasizes that he does not "HATE CPAP" and that it is an excellent treatment for patients who tolerate it. His primary concern is to protect the health of patients who never use or rarely use their CPAP machines. Dr Shapira jokes that he was a "quack" for 25 years when he was one of a few dentists using oral appliances to treat sleep apnea. When the AASM created their new parameters of care he became an "expert" in the field. He teaches courses in Dental Sleep Medicine to dentists at his Gurnee dental practice several times a year. He prides himself on teaching a balanced course that discusses many types of appliances. Dr Alex Golbin gives all of Dr Shapira's students an introduction into how a sleep lab functions. Dr Golbin presents his portion of the course at Sleep and Behavioral Medicine Institute in Vernon Hills. Dr Golbin is the author of "The World of Children's Sleep" and is the editor and one or the authors of "Sleep Psychiatry" the only medical textbook on that subject.
Dr Alex Golbin is also the founder and Editor of Sleep and Health Journal, which has recently discontinued it's printed version but is currently making nine years of archives available online. It will continue as an online Journal. An interesting article in Sleep and Health Journal comparing oral appliances and CPAP is available at http://www.sleepandhealth.com/oral-appliances-vrs-cpap-shapira another article comparing oral appliances and surgery can also be found at Sleep and Health at http://www.sleepandhealth.com/story/sleep-apnea-treatment-are-dental- ... ul-surgery The Pub Med abstracts of the two articles quoted are included at the bottom of this paper for your convenience.
The scalloping of the tongue is also a warning sign of TM Joint disorders or TMD (temporomandibular dysfunction). The NHLBI, National Heart, Lung and Blood Institute considers Sleep Apnea to be a TMJ disorder. Their report "Cardiovascular and Sleep Related Consequences of TMJ Disorders" is available online at: http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf and discusses how a vast array of problems are specifically related to TMJ disorders. An article in Cranio Journal by Shimshak et al showed by statistical anaysis that patients with TMJ disorders diagnosed had a 300% increase in medical costs in all fields of medicine.
Dr Shapira has combined the treatment of difficult TMJ problems and Sleep disorders in his Gurnee dental practice. Information about Neuromuscular dental treatment of TMJ disorders, TMD, TMJ/TMD can can be found at his dental website @ http://www.delanydentalcare.com/neuromuscular.html
Suffer No More is another article available at Sleep and Health Journal that should be read by all patients seeking help with TMJ disorders and can be found @ http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor
Patients across Chicagoland seeking help is sleep apnea diagnosis and treatment can see Dr Shapira at his Gurnee or at offices of Chicagoland Dental Sleep Medicine @ http://www.chicagoland.ihatecpap.com/ or they can call toll free at 1-8-NO-PAP-MASK 1-866-727-6275.
Otolaryngol Head Neck Surg. 2005 Dec;133(6):966-71. Links
The association of tongue scalloping with obstructive sleep apnea and related sleep pathology.
Weiss TM, Atanasov S, Calhoun KH.
Department of Otolaryngology, Southern Illinois University, USA.
OBJECTIVE: The association between OSAS and patient history and physical exam findings is previously established; however, to our knowledge there are no studies that evaluate the role of tongue scalloping as a reliable clinical indicator for OSA, snoring, or the presence of other sleep pathology as evidenced by polysomnography. This study evaluates the hypothesis that such an association exists. SUBJECTS AND METHODS: Sixty-one otolaryngology clinic patients were evaluated by history and physical exam for the presence and degree of tongue scalloping, snoring, and other previously established clinical indicators for sleep-disordered breathing and obstructive apnea. Twenty-five of the 61 study patients were additionally evaluated by overnight polysomnography to provide conclusive diagnosis of sleep pathology. The degree of tongue scalloping was graded from 0 to 3 and its significance as a screening, diagnostic, and predictive factor for sleep pathology was then statistically determined. RESULTS: Twenty-seven patients (44%) had known or newly documented OSA and 47 (77%) had a history of snoring. Twenty-seven patients (44%) had some degree of tongue scalloping (1-3) and 74% of these patients were male. The presence of any degree of tongue scalloping (grade 1-3) in patients with known or newly documented OSA showed sensitivity, specificity, PPV, and NPV of 52%, 68%, 70%, and 50% respectively. The presence of tongue scalloping in patients with either known snoring history or newly documented snoring showed sensitivity, specificity, PPV, and NPV of 47%, 64%, 81%, and 26% respectively. Presence of tongue scalloping was 71% specific for abnormal sleep efficiency (_85%), 70% specific for abnormal AHI (_5), and 86% specific for nocturnal desaturation _4% below baseline. Presence of tongue scalloping also showed PPV of 67% for abnormal AHI, 89% for apnea or hypopnea, and 89% for nocturnal desaturation. Presence and severity of tongue scalloping showed positive correlation with increasing Mallampati and modified Mallampati airway classification. CONCLUSIONS: In high-risk patients we found tongue scalloping to be predictive of sleep pathology. Tongue scalloping was also associated with pathologic polysomnography data and abnormal Mallampati grades. We feel the finding of tongue scalloping is a useful clinical indicator of sleep pathology and that its presence should prompt the physician to inquire about snoring history.
1: Sleep. 2009 May 1;32(5):648-53.Links
Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial.
Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA.
Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, Australia.
STUDY OBJECTIVES: To compare the efficacy of a mandibular advancement splint (MAS) and a novel tongue stabilizing device (TSD) in the treatment of obstructive sleep apnea (OSA). DESIGN: A randomized crossover design was used. PATIENTS: Twenty-seven patients (20 male, 7 female), recruited from a tertiary hospital sleep clinic. MEASUREMENTS AND RESULTS: The apnea-hypopnea index (AHI) was reduced with MAS (11.68 +/- 8.94, P = 0.000) and TSD (13.15 +/- 10.77, P = 0.002) compared with baseline (26.96 +/- 17.17). The arousal index decreased for MAS (21.09 +/- 9.27, P = 0.004) and TSD (21.9 +/- 10.56, P = 0.001) compared with baseline (33.23 +/- 16.41). Sixty-eight percent of patients achieved a complete or partial response with MAS, compared with 45% with TSD. The Epworth Sleepiness Scale (ESS) score was decreased with MAS (P = _ 0.001) and TSD (P = 0.002). Subjective improvements in snoring and quality of sleep were reported, with a better response for MAS than TSD. Compliance was poorer for TSD, and the side effect profiles of the 2 modalities were different. All patients were satisfied with MAS compared to TSD, and 91% of patients preferred the MAS. CONCLUSION: Objective testing showed the MAS and TSD had similar efficacy in terms of AHI reduction. Patients reported improvements with both devices; however, better compliance and a clear preference for MAS was apparent when both devices were offered. Longer term studies are needed to clarify the role of TSD.
Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.
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