Diagnostic and treatment workflow of the otorhinolaryngologists and dentists in patients suffering from the Syndrome of Obstructive sleep apnea and snoring

Abstract

Introduction. Obstructive sleep apnea and snoring syndrome is among the most commonly diagnosed sleep disorders. Physicians in dental medicine can play a valuable role in the multidisciplinary team of specialists, working to alleviate and treat the symptoms of patients, suffering from OSA and snoring syndrome. Dentists are often the worst to diagnose a symptom, typical for OSA.
Materials and Methods. For the literature overview and discussion on the topic of obstructive sleep apnea and snoring syndrome authors made a detailed literature overview, using the following keywords: obstructive sleep apnea, otorhinolaryngology, dental medicine, risk factors and time interval 2000-2023. Scientific databases PUBMED, MEDLINE, ScienceDirect and others were used. Information was taken from national scientific databases and monographic books on the topic. 545 professional drivers (mean age of 49.9 ± 8.8 years) were studied over a period of 7 years. All participants in the clinical study signed written informed consent forms and filled in written questionnaires. Criteria for inclusion of patients to the following study were: symptoms for the presence of the syndrome of sleep apnea and snoring, patients of at least 18 years of age, patients in the risk groups. All patients were tested with Weinmann® Somnocheck micro cardio. Ethical approval for the conduct of the study has been obtained by Medical University - Varna Ethic committee. Statistical analysis
has been done with SPSS 18.
Results. Male gender was prevailing in the studied group of patients. 42.4% of the examined participants in the study presented with BMI above 30 kg/m2. The highest relative proportion of individuals was between 45 and 60 years of age. Special attention should be placed at the subjective criteria ESS score>10 and interview findings. No connection between sex, BMI and ESS-results has been proven. A connection between ESS and snoring has been proven. Professional drivers who snore express higher levels of excessive daytime sleepiness and daily fatigue. The more frequent nocturnal symptoms with a wider presence in the clinical picture of patients with OSA and snoring syndrome were snoring and apneic episodes.
Discussion. The OSA phenomenon appears due to the specific anatomy of the upper respiratory tract. As obstructions appear in the oral and nasal cavity, it is normal to approach the primary examination by an ear, nose and throat doctor and a dental practitioner. The actions taken by clinicians in these two specialties, in collaboration with colleagues from other subspecialties, are decisive for the course of the treatment. The dental practitioner can screen for patients at risk for a sleep disorder and, when properly trained, to treat those individuals, using intraoral dental appliances.
Conclusions. Specialists in otorhinolaryngology, head and neck surgery and physicians in dental medicine should work more and in better collaboration when examining and prescribing treatment of OSA patients in our country. Organizing scientific events and symposia, accompanied by practical courses, significantly helps specialists to improve their knowledge and diagnostic skills in the field. Dental professionalists can often be the first to encounter a patient with hidden and non-diagnosed sleep apnea. More efforts should be invested in educating dental professionals, students and residents in OSA symptoms and screening.