Dr Aditi Desai
President, British Society of Dental Sleep Medicine
British Academy of Dental Sleep Medicine
During these unprecedented times, while healthcare systems are overwhelmed and struggling to cope, there are other areas of healthcare that require attention on an ongoing basis.
One such health burden is sleep disordered breathing, of which obstructive sleep apnoea (OSA) is the most common. The consequences of this disease are vast with overwhelming evidence to suggest that OSA patients are more vulnerable to the COVID-19 virus. The Dalai Lama once said: “sleep is the best meditation.” We must do all we can to help combat this disease and give our hospitals the help they need to focus on critical care patients.
The role of dentistry in sleep health
One might ask why I, as a dentist, write this editorial for a medical condition. As we move towards understanding the pathophysiology of this disease to provide a personalised model of care, it’s accepted that dentistry is uniquely placed to provide an alternative to CPAP. One such alternative is mandibular advancement devices (MADs), which help stabilise the airway during sleep.
One of the main causes of airway collapse is the fatiguability of the tongue and airway muscles, which do not respond to stimulation as quickly as needed.
However, while mechanical splinting of the airway with CPAP therapy and mandibular advancement devices remains the conventional route to treat these patients, alternative treatments continue to emerge.
Looking for alternative new treatments
A newly emergent neuromuscular electrical stimulation (NMES) device has been shown in clinical trials to help patients at the snoring and mild OSA end of the disease continuum, who are either unable or unwilling to access and comply with conventional treatment methods.
Patients often shy away from using any device over their face. The consequence of low compliance is low treatment efficacy. These devices are another solution for patients who do not want the burden of wearing something when they sleep.
Ensuring support for all patients
More patients have mild OSA than moderate or severe and more needs to be done to help those who may not be suitable for secondary care.
So, one wonders if more patients were offered a daytime therapy device or a mandibular advancement device earlier, would it reduce the burden on our healthcare system in more ways than one? Economies of scale would suggest starting the treatment journey early can only be beneficial to those several millions affected.