Airway Centric Orthodontics is a philosophy which trumps everything else in contemporary Orthodontics. The philosophy focuses on practice of clinical orthodontics aimed at achieving ideal jaw relationship, establish normal oral function and performance, optimal proximal and occlusal contact of teeth. The central aspect of function and performance is airway and breathing which in fact is hierarchically the most important function for humans. Ideal health and ideal facial development is dependent on correct tongue posture and nasal breathing. Therefore contemporary protocols be it Preventive, interceptive or corrective orthodontics should factor upper airway improvement in addition to improving smile and facial appearance. Today Orthodontic profession is crucial and integral part of the interdisciplinary team in the management of upper airway sleep disorders, thus well poised to become a part of mainstream health profession. The paper would revisit the decision making process in orthodontics and discuss orthodontic strategies to improve the vital human airway which is essential for good health, longevity, and well-being.
Obstructive sleep apnea (OSA) is a common disorder that is characterized by obstructive apnoeas and hypopneas due to the repetitive collapse of the upper airway during sleep. A variety of effective behavioral and airway-specific therapies are available for the treatment of OSA, including weight loss, positive airway pressure therapy, oral appliances, and surgical procedures. Behavior modification is indicated for most patients who have OSA. This includes losing weight, exercising, abstaining from alcohol, and avoiding certain medications. For patients with severe OSA, positive airway pressure is recommended as initial therapy. Oral appliance may be tried for patients with mild to moderate OSA. Surgical therapy is usually for the surgically correctable obstructing lesion. Hypoglossal nerve stimulation via an implantable neurostimulator device is a novel treatment strategy. Patients who continue to have excessive daytime sleepiness despite adequate OSA-specific therapy that is severe enough to warrant treatment may benefit from adjunctive pharmacologic therapy like modafinil and armodafinil. Other drugs have been tried in the management of OSA. In small trials, benefits have been found sporadically with remifentanil, zolpidem, triazolam, eszopiclone, and sodium oxybate. Further large multicentric trials are required to prove their efficacy. There is also a scope for research for thedevelopment of some novel group of drugs for the primary treatment for OSA.
Introduction: Sleep disordered breathing (SDB) is being recognized as a risk factor for stroke. OSA is easily modifiable; the diagnosis is simple, and the treatment straight-forward. These characteristics make OSA an ideal target for interventions aimed to reduce cerebrovascular disease burden. However, data from India is lacking.
Methodology: Fifty subjects with a history of recent onset stroke, and hundred matched controls were recruited. A comprehensive history and other relevant features were recorded. After the acute phase of the stroke was over, the patients underwent an overnight polysomnography (PSG). The sleep architecture was also analyzed.
Results and Conclusions: SDB was seen in 78% stroke patients but in only 28% of controls (OR 9.1169 (95 % CI 4.1009 to 20.2684) P < 0.0001). Mixed apnea was seen in 53.85% of the cases and was the predominant type of sleep apnea observed. The prevalence of SDB was high in stroke patients with obesity and congestive cardiac failure. We found a reduction in total sleep time, sleep efficiency and REM sleep in stroke patients and an increased stage 2 sleep. Also, stroke topography affected sleep architecture with patients with multiple sites involved having decreased REM sleep.
Background: Restless leg syndrome (RLS) or Willis-Ekbom disease is a common disorder. It may present with excessive daytime sleepiness (EDS). EDS is seen often in obstructive sleep apnea (OSA) as well. Obesity and diabetes mellitus (DM) can be associated with both RLS and OSA.
Aim: To study the prevalence of RLS among patients with suspected OSA.
Material and Method: A retrospective evaluation of data was performed from proforma of patients referred for polysomnographic evaluation of OSA from January 2015 to December 2015 at a tertiary care post-graduate teaching institute. The sleep proforma through which the datawas collected also had RLS diagnostic criteria.
Result: Out of 69 patients who underwent the sleep study for suspected OSA, 9 (13%) patients fulfilled the diagnostic criteria of RLS. The majority of the patients i.e. 7/9 (78%) were women while 2/9 (22%) were men. The mean age was 50 ±3.5 years. History of excessive daytime sleepiness (EDS) was positive in 8 cases with the Epworth sleepiness score (ESS) of > 8. History of snoring was present in all 9 cases. Six out of 9 cases had a history of insomnia. The mean body mass index (BMI) was 34.5± 4.2 kg/m2. On polysomnography, three patients were diagnosed to have OSA with anapnea-hypopnea index of 5.2, 15 and 42 per hour. Periodic limb movement in sleep (PLMS) was documented in 7/9 (78%) patients. Eight out of 9 cases had secondary RLS, 4 due to diabetes, 2 had iron deficiency and the remaining 2 patients had RLS because of chronic obstructive pulmonary disease.
Conclusion: RLS is common among patients suspected with OSA. Screening of RLS should be done in all OSA suspect cases to prevent misdiagnosis and mismanagement of RLS in patients.
Narcolepsy, a disorder of the borderline between wakefulness and sleep is rarely diagnosed in the pediatric population. This is despite the fact that majority of narcoleptic signs and symptoms begin in the second decade. Misdiagnosis and delayed diagnosis inadvertently leads to increased social and economic burden on the children and their families with interference in normal mental and physical well being and academic performance. The commonest cardinal symptom of narcolepsy is excessive daytime sleepiness. However, patients with narcolepsy have significantly disturbed sleep patterns and may have associated mood disorders. This report describes a child presenting with acute insomnia who was found to have narcolepsy.