Sleep Apnea

Sleep Apnea Conference for Dentists

presented on August 9, 2014 at Lebanese Dental Association, Corniche El Nahr, Beirut - Lebanon , by Dr. Nabil C. KHOURY.

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Introduction and epidemiology

The sleep apnea syndrome which is a common chronic health problem as diabetes, hypertension etc …, is often still unknown and is still a “hidden” or “secret” disease. All efforts should be deployed to clarify it. Public campaigns and awareness should be undertaken at all levels, mainly by health –care providers such as doctors, sleep medicine specialists and expert technologists.

You should know that nearly 5% of women and 10% of men of the adult population are affected by this disease and still are undiagnosed and untreated. We hope that this special online campaign which is addressed to the public by using simple, clear and easy-to-understand medical explanation and information can shed more light on this important and sometimes dangerous health problem and can help people to be more aware of this disease and consult as soon as possible their doctors or any sleep medicine center or clinic.


Do you complain of ?

  1. Snoring
  2. Excessive daytime sleepiness
  3. Excessive daytime chronic fatigue
  4. Witnessed cessation or slowing of breathing by your bed partner
  5. Chocking during sleep
  6. Panic event during sleep
  7. Nocturnal and/or morning headache
  8. Memory and/or work concentration loss
  9. Pulmonary hypertension diagnosed by your doctor
  10. Chronic obstructive pulmonary disease
  11. Frequent aspiration pneumonias
  12. Stroke
  13. Depression or any other psychiatric problem
  14. Severe refractory hypertension
  15. Congestive heart failure
  16. Palpitations or arrhythmias
  17. Coronary artery disease
  18. Gastro-esophageal reflux
  19. Chronic hoarseness
  20. Chronic nasal obstruction
  21. Nocturia
  22. Sexual impotence or erectile dysfunction

Do you have any of these risk factors?

  1. Obesity
  2. Age 40-65
  3. Short and large neck
  4. Upper airway obstructive disorder (enlarged tonsils, adenoids…)
  5. Sleeping on back
  6. Familial occurrence
  7. Alcohol abuse
  8. Sedatives abuse
  9. Smoking

If yes, mainly snoring and/or excessive daytime sleepiness and excessive chronic daytime fatigue, most probably you are suffering of “sleep apnea syndrome” .Although this disorder is frequent as asthma, diabetes etc…it is still lacking early or adequate diagnosis .That’s why it is called the “hidden or secret disease”.


What is sleep apnea? (Especially the most common form obstructive sleep apnea).

Usually, the muscles of the upper respiratory tract collapse during sleep in normal individuals. If this collapse is exaggerated (still for an unknown reason), the airway passage of the upper respiratory tract becomes obstructed, which causes snoring during sleep in some individuals. If the obstruction is bigger, this will lead to difficulty in breathing. In some cases, the obstruction is complete, which will lead to a pause of breathing secondary to this obstruction and may last up to 10 seconds or more. This type of pause may be repeated several times during sleep up to hundred times even during one single night.

If you are complaining of this situation, you are forcing to breathe anytime this obstruction occurs, which will impose a huge pressure and impact .on the brain and cardiovascular system. Your sleep is disrupted night after night, you are complaining of chronic fatigue and excessive daytime sleepiness, which will have a negative impact on your daily life work and your relationship with your surroundings. Your partner (or your husband or wife) may witness your breath pauses during sleep and your loud snoring.


Sleep apnea has 3 forms, the most frequent and severe one is obstructive sleep apnea (OSA), defined in the previous section.

  1. Obstructive 85%
  2. Central 1%
  3. Mixed 14%


what are the health hazards of this disorder? :

  1. Refractory severe hypertension
  2. Stroke
  3. Myocardial infarction and/or arrhythmias
  4. Diabetes
  5. Pulmonary hypertension
  6. Depression and other psychiatric problems
  7. Sudden death

You should also know that

  1. More than 35% of sleep apnea patients complain of severe refractory hypertension, which increases the risk of cardiac disease.
  2. More than 83% of patients with severe refractory hypertension with 2 or more anti-hypertensive agents complain of sleep apnea syndrome.
  3. Approximately 70% of stroke patients have this sleep apnea syndrome.
  4. The risk of sleep apnea patient to sustain a car accident is 7-fold greater than a normal person.

Epworth scale

the most easy, simple and reproducible test to perform, in order to assess, score your level of sleepiness and to take the necessary measures accordingly.

The Epworth sleepiness scale can help you or your doctor measure the level of sleep deprivation and about whether you should be evaluated further for obstructive sleep apnea.

Score each item based on your recent and usual behavior .if you have not done some of these things recently, think about how they affected you in the past. Circle the most appropriate number for the situation:

Case Degree of Evaluation
No change of dozing (sleep) 0
Slight chance of dozing 1
Moderate chance of dozing 2
Moderate chance of dozing 3

Situation/position evaluation
Siting and reading 0
Watching TV 1
Sitting inactive in a public place 2
As a passenger in a car for an hour without break 3
Lying down to rest in the afternoon 3
Sitting and talking to someone 3
Sitting quietly after lunch (without alcohol) 3
In a car ,while stopped for a few minutes in traffic 3

Total Score Result
0-4 Normal
5-9 Possibility of Sleep Apnea
10-15 Consult your doctor
>16 Consult sleep clinic immediately

You should know that many individuals, who have the risk factors listed previously, don’t complain of the various symptoms of sleep apnea disorder. Here they should undergo by themselves the Epworth sleeping test and consequently consult their doctor or the sleep clinic.

The early diagnosis of this disorder may lead to a better and faster treatment and may prevent the severe health complications.

Polysomnography (sleep study)

When you consult your doctor or a sleep clinic, with high clinical suspicion of sleep apnea syndrome, and after evaluating your sleepiness severity on the Epworth scale, you should always perform a polysomnography study to confirm the diagnosis and to evaluate your level of sleep apnea (mild, moderate, severe) and assess your treatment modality accordingly.

There are 2 types of sleep study:

1.Home polysomnography
(performed at home)
2.Lab polysomnography
(performed in the lab)

Both of them are accurate, simple to do although the lab polysomnography is well controlled and monitored overnight by the sleep technologist and performed in a highly specialized environment.


There is a very effective treatment of this syndrome called continuous positive airway pressure (CPAP or auto-CPAP) or bi-level positive airway pressure (BIPAP or auto –BIPAP). It consists of a small portable device which can be put at the bedside of the patient and it delivers pressured air through a nasal mask or through any other interface. This positive pressured air will keep the airway open during sleep and prevent the collapse and narrowing of the airway and consequently will alleviate the snoring and pause of breathing (apnea). This treatment doesn’t need any drugs or surgery and has proved its efficiency worldwide, and has led to a normal, deep and silent sleep and consequently a healthy normal life. The positive effect of this treatment is apparent since the early first days of its application.


The early diagnosis and recognition of obstructive sleep apnea is crucial, as the early application of the highly effective treatment described previously, can prevent the severe and sometimes fatal complications of this “hidden disease”.