Prevalence and risks of habitual snoring and obstructive sleep apnea symptoms in adult dental patients

Craniofacial anatomical determinants of pediatric sleep-disordered breathing: A comprehensive review

PURPOSE

This narrative review aims to elucidate the anatomical features of sleep-disordered breathing (SDB) in children. By identifying key structures and intervening proactively, we seek to alter craniofacial growth patterns and improve functional outcomes for SDB children.

METHODS

The literature on pediatric sleep-disordered breathing (PSDB), pediatric obstructive sleep apnea (OSA), anatomical predispositions, and the relationship between skeletal deformity and PSDB was examined using PubMed and Google Scholar databases, covering studies from 2006 to 2024.

RESULTS

Forty relevant articles were reviewed, focusing on craniofacial characteristics associated with PSDB. The etiology of PSDB is multifactorial, with adenoid and palatal tonsil enlargement being the most common cause. While adenotonsillectomy is recommended as the primary treatment, residual SDB may result in craniofacial skeletal deformities contributing to upper airway constriction. Typical craniofacial phenotypes of SDB include excessive vertical growth and constriction of the maxilla, a retruded mandible, and posterior rotation, known as a Class II hyperdivergent pattern. Conversely, Class III with an underdeveloped maxilla shows a relatively lower risk for SDB due to reduced nasal cavity and nasopharyngeal airway volumes. Transverse maxillary constriction with a high, deep palatal vault is a significant risk factor. Additionally, nasal obstruction and low tongue posture, with or without a short lingual frenulum, are identified as craniofacial risk factors for SDB development in children.

CONCLUSION

Early diagnosis and intervention are critical in managing PSDB. Dentists, through screening and early treatment, can significantly influence craniofacial growth and health outcomes. A multidisciplinary approach is essential for effective management, improving the quality of life and long-term health of affected children.

Causal associations between sleep traits and temporomandibular disorders: a bidirectional mendelian randomization analysis

Objectives

This study aims to investigate the relationship between five sleep traits (insomnia, sleep duration, getting up in morning, snoring, and daytime nap) and temporomandibular disorders (TMD) using bi-directional Mendelian randomization.

Methods

The bi-directional Mendelian randomization study was conducted in two stages. Initially, sleep traits were examined as exposures while TMD was evaluated as an outcome, whereas the second step was reversed. The inverse variance weighted (IVW) method and other Mendelian randomization methods were used for analysis. Furthermore, we performed the MR-Egger intercept, MR-PRESSO, Cochran's Q test, and "Leave-one-out" to assess the levels of pleiotropy and heterogeneity.

Results

The IVW method indicates that getting up in the morning reduces the risk of developing TMD (OR = 0.50, 95% CI 0.30-0.81, p = 0.005), while insomnia may increase the risk of TMD (OR = 2.05, 95% CI 1.10-3.85, p = 0.025). However, other sleep traits are not associated with the risk of TMD, and having TMD does not alter an individual's sleep traits. After removing outliers, the results remained robust, with no pleiotropy detected.

Conclusion

Genetically determined difficulty in getting up in the morning and insomnia can increase the risk of TMD. By optimizing sleep, the risk of developing TMD can be reduced. This underscores the importance of sleep in preventing TMD.

Sleep patterns and quality among Nigerian medical students: A cross-sectional study

Adequate sleep is crucial for individuals' well-being and cognitive functioning. However, medical students face unique challenges that disrupt their sleep patterns, such as a rigorous curriculum, long study hours, and high-stress levels. Understanding the sleep patterns and quality among medical students in Nigeria is important to develop targeted interventions and support their overall well-being. This study involved 802 medical students from 3 medical schools in Southwest Nigeria. Participants completed an online questionnaire that collected data on their demographic characteristics, sleep patterns and self-reported sleep quality. Descriptive statistics and correlation analysis were used to analyze the data and identify patterns and associations. Most participants were female (56.9%), with the highest representation from the UNILORIN (65.5%). The average reported sleep duration was 5.74 hours per night, indicating insufficient sleep. Irregular bedtimes and wake-up times were commonly reported. A significant proportion of students consumed coffee late at night (27.1%) and used medication to induce sleep (24.3%). Sleep patterns and behaviors, such as snoring (36.1%) and nocturnal eating (57.6%), were reported. Overall, participants reported satisfactory (28.3%) or poor (29.7%) sleep quality. Correlation analysis revealed significant associations between sleep patterns, sleep quality, academic performance, and other sleep-related factors. The study identified insufficient sleep duration, irregular bedtimes, late-night coffee consumption, and poor sleep quality. These findings emphasize the need for interventions and strategies to promote healthy sleep habits among medical students, which can positively impact their overall health and academic performance.

Screening practices for obstructive sleep apnea in healthy community people: a Chinese community-based study

Background

Owing to the lack of clear guidelines, the significance of obstructive sleep apnea (OSA) screening in healthy community people is unclear. This study aimed to screen for OSA in a healthy community population and provide a basis for its screening.

Methods

Permanent residents from five communities in the coastal and mountainous areas of south China were selected. The screening process included demographic and sleep questionnaire surveys, and an OSA screening. To compare the prevalence and risk factors of OSA in different areas, a type IV wearable intelligent sleep monitor (WISM) was used for screening.

Results

A total of 3,650 participants completed all studies, with a mean age of 53.81±12.71 years. In addition, 4,318 participants completed the OSA screening within 30 days, and the objective screening speed was 200 people per day. The recovery rate of the screening equipment was 99.37% (4,291/4,318), the screening success rate was 89.63% (3,846/4,291), and the rejection rate was 2.7% (120/4,438). The prevalence of high-risk OSA screened using the Stop-Bang questionnaire was 42.8% (1,563/3,650) and that screened using the device was 30.7% (1,119/3,650). The prevalence of OSA screened using the Stop-Bang questionnaire was higher than that screened using the device (P<0.01). Further analysis of sleep quality and daytime sleepiness showed that 47.6% (1,736/3,650) of the community population had good sleep quality and 6.6% (240/3,650) had daytime sleepiness. Age, sex, body mass index (BMI), neck circumference, and hypertension were risk factors for OSA in the community population.

Conclusions

The use of objective type IV sleep detection equipment to screen a large sample population in the community in a short time is feasible. The prevalence of high-risk OSA screened using the Stop-Bang questionnaire was higher than that screened using the objective screening device.

Identification of Patients at Risk of Obstructive Sleep Apnea in Dental Settings

Objectives This study aims to assess the risk of obstructive sleep apnea (OSA) in the Saudi Arabian population at a dental hospital using the Berlin Questionnaire (BQ) and investigate the association of gender, age, neck circumference, systolic blood pressure (SBP), diastolic blood pressure (DBP), and smoking habits with the risk of OSA. Methodology Participants were recruited through random selection from walk-in patients aged between 18 and 80 years. BQ was used to screen for OSA. In addition, age, gender, smoking habits, neck circumference, and blood pressure were collected. Data were analyzed using descriptive statistics, Student's t-test, and chi-square test. Results In this study, 55 participants were screened for OSA using BQ. Of the participants, 44 (80%) were considered to be at low risk of OSA. Age, neck circumference, BMI, SBP, and DBP were statistically significantly associated with high risk of OSA (P < 0.05). Age and neck circumference were found to be statistically significant predictors of OSA, even after controlling for gender and smoking status (P < 0.05). Conclusions BQ is a reliable tool for assessing the risk of OSA in the Saudi Arabian population. Age, neck circumference, BMI, SBP, and DBP are all significant factors of OSA, while age and neck circumference are significant predictors of OSA. Dental practitioners can play a valuable role in the early detection and referral of patients at high risk of OSA.

Prevalence of Sleep Disorders Among the General Population of the Jazan Region of Southwest Saudi Arabia

BACKGROUND

Sleep disorders impose a substantial burden on the global population, leading to an array of health complications. Understanding their prevalence and associated risk factors is crucial to formulating effective interventions.

OBJECTIVE

This study aimed to determine the prevalence and associated risk factors of sleep disorders among residents of the Jazan region of Saudi Arabia.

METHODS

This cross-sectional study conducted an online survey from December 2022 to March 2023. The sample comprised 670 respondents aged 18 years and older residing in Jazan. Demographic data, lifestyle habits, sleep patterns, and sleep disorder symptoms were assessed.

RESULTS

The participants were predominantly women (62.2%), with an average age of 30.99 years and a normal body mass index. The analyses revealed that 28.8% of the respondents reported experiencing sleep disorders, and 13.4% particularly had obstructive sleep apnea. Nearly half of the participants reported having primary insomnia, excessive daytime sleepiness, and restless leg syndrome. Significant associations were found between sleep disorders and older age (p = 0.012), obesity (p = 0.043), short or thin neck (p = 0.034), smoking (p = 0.003), caffeine use (p = 0.001), existing health conditions (p = 0.001), medication use (p = 0.013), lack of daytime naps (p = 0.043), and frequent nighttime awakenings to urinate (p = 0.001). The most common self-reported reasons for nightly awakenings were urination, anxiety or stress, discomfort or noise, and health conditions.

CONCLUSIONS

The findings suggest a high prevalence of sleep disorders among adults in Jazan, Saudi Arabia. Various demographic, lifestyle, and health-related factors are linked to these disorders. Therefore, targeted sleep health education and interventions could be instrumental in tackling this significant public health issue.

Study of the obstructive sleep apnea syndrome in cerebral infarction patients

Introduction

Obstructive Sleep Apnea Syndrome (OSAS) is the most common respiratory disorder during sleep. Many studies have shown an association between obstructive sleep apnea syndrome and stroke, and OSAS has not been adequately considered in Vietnam compared to the actual clinical dangers. This study aims to assess the prevalence and general characteristics of obstructive sleep apnea syndrome in patients with cerebral infarction and investigate the relationship between obstructive sleep apnea syndrome and the severity of cerebral infarction.

Methods

Descriptive cross-sectional study. We identified 56 participants from August 2018 to July 2019. Subacute infarcts were identified by neuroradiologists. For each participant, vascular risk factors, medications, clinical symptoms, and neurological examination were abstracted from the medical record. Patients were taken for history and clinical examination. The patients were divided into two groups according to their AHI (Apnea-Hypopnea Index) (<5 and ≥5).

Results

A total of 56 patients were registered for the study. The mean age is 67.70 ± 11.07. The proportion of men is 53.6%. AHI has a positive correlation with neck circumference (r = 0.4), BMI (r = 0.38), the Epworth Sleepiness Scale (r = 0.61), LDL cholesterol (r = 0.38), the Modified Rankin Scale (r = 0.49), NIHSS (National Institutes of Health Stroke Scale) (r = 0.53), and an inverse correlation with SpO₂ (r = 0.61).

Conclusion

Obstructive sleep apnea Syndrome is a factor in the prognosis of cerebral infarction as well as cardiovascular diseases such as hypertension. Thus, understanding the risk of stroke in people with sleep apnea is necessary and working with a doctor to diagnose and treat sleep apnea is important.

Obstructive Sleep Apnea in Hypertension

Introduction About one-half of patients who have essential hypertension have obstructive sleep apnea (OSA), and about one-half of patients who have obstructive sleep apnea have essential hypertension. OSA can cause even resistant hypertension if left untreated. These two entities often co-exist and are seen as a continuum of the same process. Eighty percent to 90% of OSA cases are undiagnosed mostly because of a lack of awareness. Material and methods This was a cross-sectional study done over a period of one year in a tertiary care hospital. After taking informed consent, 179 hypertensive patients of >18 years were included in the study. All patients were screened for OSA by the STOP-BANG questionnaire. Patients having scores of ≥3 were subjected to overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Patients with a STOP-BANG score ≤2 or score ≥3 with AHI <5, were considered non-OSA. Results More than half (53.1%) of the patients enrolled in the study had OSA. Their age ranged from 18 to 78 years and the mean age was 52.07±11.40 years. The mean age of OSA cases was found to be slightly higher than that of non-OSA. The majority of OSA cases were males (73.7%). There was an increase in the prevalence, as well as the severity of OSA, with an increase in BMI. Most of the cases had snoring and a history of tiredness. Triglyceride (TG) and low-density lipoprotein (LDL) levels of the OSA group were found to be significantly higher and high-density lipoprotein (HDL) levels were significantly lower than that of the non-OSA group. Conclusion More than half of our hypertensive patients had OSA. These two conditions often co-exist and are known as a dangerous pair. Physicians ought to have increased suspicion for early diagnosis and treatment to improve cardiovascular outcomes, reduce road traffic accidents, and improve quality of life.

Nasal Blockage and Academic Performance Among Medical College Students in the Kingdom of Saudi Arabia

Objectives The most frequent otolaryngological complaint is nasal obstruction. We aimed to determine if there is a relationship between nasal blockage and academic performance among medical college students in Saudi Arabia. Methods This cross-sectional survey carried out from August to December 2022, included 860 medical students determining the risk of obstructive sleep apnea (OSA) on the participants using the Berlin Sleep Questionnaire Risk Probability, then comparing it to their socio-demographic characteristics, while the Chi-square test was used for the comparison of categorical variables. Result The average age of the participants in our study was 21.52 years; 60% were females and 40% were males. The risk of obstructive sleep apnea was found to be two times higher in females than in males (95% CI: 1.195- 3.345; p-value 0.008). The hypertensive participants had a 27-fold increased risk of OSA compared to non-hypertensives. Grade Point Average (GPA) and snoring had a statistically significant relationship, however, a fifth of the participants reported snoring (79.8% reported not snoring). We also found that 14.8% of the participants with snoring had a GPA between 2-4.49 compared to 44.6% of participants without snoring. Conclusion Female students had a two-fold higher chance of developing OSA than males. While a GPA of 4.5 and above was more often associated with participants without snoring, the number of individuals with a GPA of 2-4.49 was greater among participants with snoring. To aid in the prevention of illness complications and the management of risk factors, additional efforts should be made to increase disease knowledge among students, primary healthcare practitioners, and specialty doctors.

Obstructive Sleep Apnea Awareness Among Dentists in Saudi Arabia: A Cross-Sectional Study

OBJECTIVES

This study aims to assess the knowledge and clinical practices among dentists in Saudi Arabia regarding obstructive sleep apnea (OSA).

MATERIAL AND METHODS

This cross-sectional study was conducted over a period of 8 months across the whole country. A self-administered questionnaire was used to assess the OSA knowledge and practices. The developed questionnaire was closed-ended questions and consisted of three parts: (1) demographic information such as age, gender, work experience, workplace, and specialty; (2) knowledge of OSA; and (3) OSA management practice. The knowledge score was calculated based on six questions, each of which gives one point when answered correctly.

RESULTS

A total of 450 dentists from all over the country were surveyed, with a predominance of females (55.6%) and Saudis (59%). About 56% learned about OSA in their undergraduate study, with theoretical lectures being the main source of information. The overall knowledge score was 3.09, with specialists having a higher score than general practitioners (GPs) (p<0.001) and those who learned about OSA in their post-graduate study having higher scores (p<0.001). Despite this, 58.89% never asked their patients about sleep history, and only 19.11% diagnosed patients with OSA before. Only 7.56% used oral appliances to treat OSA, and only one-quarter referred patients to a physician for a sleep-disordered diagnosis. However, 79.33% were willing to attend a continuing education course on managing OSA patients.

CONCLUSION

Our study shows that dentists in Saudi Arabia lack fundamental understanding regarding OSA and their role in screening, diagnosing, and treating patients with OSA, highlighting the need to educate the dental fraternity. Dental GPs and specialists, including orthodontists, must be actively involved in diagnosing and treating this life-threatening health issue.

The influence of obstructive sleep apnea on self-perceived dental aesthetics and need for orthodontic treatment among the general population in Makkah, Saudi Arabia

OBJECTIVE

To assess the influence of obstructive sleep apnea on self-perceived dental appearance and need for orthodontic treatment.

MATERIALS AND METHODS

A self-administered questionnaire was used in a random sample of a general adult population in Makkah region, Saudi Arabia. A total of 1014 participants completed the questionnaires, which included the STOP-BANG questionnaire, Oral Aesthetics Subjective Impact Score questionnaire, and Aesthetic Component of Index of Orthodontic Treatment Need questionnaire. Descriptive statistics and Chi-square tests were used to compare differences between the groups.

RESULTS

Overall, 6.5% (66/1014) of the participants were classified as being at high risk of OSA of which 71.2% were males and 28.8% were females (P < 0.001), 57.6% were >50 years of age, 90.9% had obesity, and 81.8% had an enlarged neck circumference. But only 10.1% of the participants reported that they snore loudly. A positive self-perception of dental esthetics was found in 42 (6.2%) and 518 (76.6%) participants at high and low risk of OSA, respectively. Furthermore, of the participants in the high- and low-risk groups, 4.2% and 66.7% considered themselves in need of orthodontic treatment, respectively.

CONCLUSIONS

The prevalence rate of people at intermediate to high risk of OSA was 26% of the general population and being at high risk of OSA had no influence on self-perceived dental esthetics and need for orthodontic treatment.

Prevalence and Risk of Obstructive Sleep Apnea and Association with Orofacial Symptoms in Patients Attending the Dental Clinics

Background

Dentists have a vital role in detection of the signs and symptoms of obstructive sleep apnea (OSA) as it modifies in anatomy of orofacial structures.

Aims and Objectives

This study aims to assess the prevalence of OSA risk in patients attending dental department and explore the factors related with high-risk OSA.

Materials and Methods

The study was carried in the Al-Farabi Dental College, Jeddah, Saudi Arabia, on 200 consecutive dental patients from June 1, 2018, to July 31, 2019. Demographic details and the OSA risk were evaluated based on the Berlin questionnaire (Arabic version). Two qualified investigators independently did anthropometric measurements, medical and dental examination.

Results

About 3.7% of males and 13.8% of females were found to be at high risk of OSA. Obese individuals almost had twice more likely chance to have OSA symptoms.

Conclusion

Our findings confirm that dentists have an important role in recognizing the OSA signs and symptoms.

Knowledge of Obstructive Sleep Apnea among Dental Fraternity in Riyadh

AIM:

To assess and compare the knowledge of obstructive sleep apnea (OSA) among final years dental students, interns, dental practitioners and faculty working in and around Riyadh.

METHODS:

A questionnaire-based study comprising of 16 questions was conducted among final year dental clinical students, interns, dental practitioners and faculty working in and around Riyadh. Statistical Package for Social Sciences software (SPSS version 21) was used to analyse the statistical data. The p < 0.05 was considered statistically significant.

RESULTS:

A total of 450 respondents took part in the study. When gender comparison was done regarding the awareness of OSA, statistically significant differences were noted for the majority of questions. The response rate for the knowledge-based questions varied statistically concerning their speciality and educational qualifications. 65% of the participants admitted that they were unaware of the diagnostic tests performed for diagnosing these patients. It was noted that 85% of the participants wanted to attend a CDE program to know more about OSA.

CONCLUSION:

The study concludes that there is a significant lack of knowledge among final year students, interns and general dentists. This study emphasises the need for all dental professionals to regularly update their knowledge and equip themselves to identify and treat such patients at an early stage.

Prevalence and risk factors of people at-risk of obstructive sleep apnea in a rural community of Odisha, India: a community based cross-sectional study

BACKGROUND

Obstructive sleep apnea (OSA) is a progressive sleep disordered breathing condition characterized by repeated episodes of upper airway collapse during sleep. Despite being the most common sleep apnea, it often remains undiagnosed and untreated, especially in rural communities. There is a paucity of literature estimating the prevalence of the disease and associated risk factors from the rural population of Odisha.

METHODS

It is a cross-sectional study that was conducted in a rural community of Odisha, India to find out the prevalence of people living with the risk of OSA. Multi-staged sampling was done. Participants were evaluated using the Berlin questionnaire (BQ) after obtaining informed consent. Data were analyzed using SPSS with the significance level set at 95%. Univariate and multivariate analysis was done to evaluate the risk factors associated with the condition.

RESULTS

Out of 200 community dwellers surveyed using the BQ, 25% had a high likelihood of OSA. Among these high risk subjects, snoring was reported by 70%, excessive daytime sleepiness by 50%. Out of those who were at risk of OSA, 28% were smokers and 48% reported alcohol use. The associated risk factors were age >35 years (OR = 4.5, 95% CI = 1.4-13.8, p < 0.05), BMI ≥ 25 kg/m² (aOR = 3.5, 95% CI = 1.2- 10.5, p < 0.05), alcoholism (aOR = 4.5, 95% CI = 1.8-11.1, p = 0.001), and hypertension (aOR = 11.5, 95% CI = 4.7-28, p < 0.001). The prevalence was not affected by the type of diet (vegetarian vs non-vegetarian), use of tobacco or tea consumption.

CONCLUSION

OSA is highly prevalent in the rural community of Odisha. Independent risk factors associated with such subjects were obesity, regular alcohol consumption, and hypertension. Further prevalence studies are recommended.

Prevalence of sleep-disordered breathing and associations with orofacial symptoms among Saudi primary school children

Background

This study aimed to determine the prevalence of sleep-disordered breathing among primary school children in Riyadh, Saudi Arabia, and to evaluate associations between sleep-disordered breathing and respiratory conditions/orofacial symptoms.

Methods

In this cross-sectional study, 1600 questionnaires were distributed to Saudi boys and girls aged 6–12 years from 16 primary schools in Riyadh. The questionnaire covered relevant demographic and personal characteristics, presence of respiratory conditions and orofacial symptoms, and the Pediatric Sleep Questionnaire. The latter was used to assess the prevalence of symptoms of sleep-disordered breathing and was completed by the participating children’s parents.

Results

In total, 1350 completed questionnaires were returned (85% response rate). The children’ mean age was 9.2 ± 1.8 years; 733 (54.3%) were boys and 617 (45.7%) girls. Overall, 21% of children were at high risk of sleep-disordered breathing. The prevalence of snoring was 14.4% and that of sleep apnea 3.4%. Boys were at higher risk of sleep-disordered breathing than girls (P = 0.040). Children with respiratory conditions or orofacial symptoms were at higher risk of sleep-disordered breathing (P < 0.0001) than children without these conditions/symptoms.

Conclusions

Around 21% of Saudi children are at risk of sleep-disordered breathing. There is a strong association between sleep-disordered breathing symptoms and the presence of respiratory conditions or orofacial symptoms.