Targeting a Good Night’s Sleep by Dr. Meghna Dassani

Navigating adult sleep apnea through screening and clinical exams

by Dr. Meghna Dassani

• Obstructive sleep apnea (OSA).
• Central sleep apnea (CSA).

• STOP-Bang Questionnaire. This widely used assessment typically consists of eight questions, associated with the categories that follow. People receive a score based on their responses to these questions, which helps categorize their sleep apnea risk as mild, moderate or severe.
• Snoring.
• Tiredness during the day.
• Observed apneas.
• Blood pressure.
• BMI.
• Age.
• Neck circumference.
• Gender (men are more likely to have sleep apnea).
• Berlin Questionnaire. This tool focuses on snoring, daytime sleepiness and hypertension, and categorizes people into low, intermediate or high risk.
• Epworth Sleepiness Scale. This self-assessment questionnaire measures a person’s daytime sleepiness or likelihood of falling asleep in various situations. The scale is widely used in clinical and research settings to help health care professionals understand the impact of sleepiness on a person’s daily life.

• Large neck. Men with a neck circumference of 17 inches or greater and women with a neck circumference of 15 inches or greater are at a higher risk of having obstructive sleep apnea.
• Scalloped tongue. This is considered by some as a marker for sleep apnea.
• Recessed chin or retrognathic mandible.
• Enlarged tonsils. Patients with Grade 3 and Grade 4 tonsils are at a high risk for OSA.
• Vaulted palate. A high, arched palate provides enough room for the tongue to rest in, contributing to the possibility of it falling back and obstructing the airway.
• Nasal obstruction. Evaluate for deviated nasal septum, enlarged turbinates that may be contributing to the obstruction.
• Eroded enamel.

• Eye movements. An electrooculogram (EOG) records eye movements, which are important for identifying types of sleep stages. Rapid eye movement (REM) is a characteristic of the sleep stage in which apnea frequently occurs.
• Brain activity. An electroencephalogram (EEG) measures electrical activity in the brain. It helps determine different sleep stages (REM and non-REM sleep) and identify abnormalities in sleep patterns.
• Muscle tone. An electromyogram (EMG) can identify periods of muscle relaxation (such as during REM sleep) or muscle tension (during wakefulness or non-REM sleep).
• Heart rate. An electrocardiogram (ECG or EKG) records the electrical activity of the heart. It helps monitor heart rate and rhythm during sleep, which can reveal potential cardiovascular issues.
• Respiratory effort. Respiratory effort belts or sensors are used to monitor chest and abdominal movements, which provide information about breathing patterns and potential interruptions.
• Blood oxygen saturation. By measuring blood oxygen levels, pulse oximetry can detect drops in blood oxygen saturation that could be indicative of sleep apnea episodes.
• Nasal and oral airflow. Sensors near the nose and mouth monitor airflow, helping to detect episodes of partial or complete cessation of breathing.
• Snoring. A microphone may be used to record snoring sounds, because loud and persistent snoring is often associated with sleep apnea.
• Body position. Sensors can monitor changes in body position during sleep, which offers insights into how sleeping posture affects sleep apnea.

• Continuous positive airway pressure (CPAP) therapy is considered the gold standard of sleep apnea treatments. It involves a mask worn over the nose and/ or mouth during sleep while the CPAP machine delivers a continuous flow of air to prevent the airway from collapsing.
• For patients who have trouble complying with CPAP therapy, oral appliances along with lifestyle modifications can be effective. Oral appliances reposition the jaw and tongue and help keep the airway open, while myofunctional therapy involves exercises targeting the muscles of the mouth and throat. Strengthening and retraining these muscles can improve the airway’s stability during sleep.
• Sometimes anatomical factors contribute to sleep apnea. These factors include a tongue tie and enlarged tonsils or adenoids. In these cases, surgical interventions may be necessary.
• For a tongue tie, also known as ankyloglossia, a frenectomy in conjunction with myofunctional therapy may be needed, along with other treatment modalities such as oral appliance therapy.
• Enlarged tonsils and adenoids are more commonly associated with children but can also affect adults. And when they do, an adenotonsillectomy may be necessary to remove the enlarged tonsils and adenoids causing the airway obstruction.

Dr. Meghna Dassani, an international speaker on sleep apnea treatment for adults and children, has been practicing dentistry in Houston for 17 years. After earning her BDS degree from the University of Mumbai, Dassani owned and operated a private practice in Mumbai for six years, then moved to the United States and earned a DMD at Boston University Goldman School of Dental Medicine. She practiced as an associate in Houston before opening Dassani Dentistry in 2011.