Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia
Dr. Liao, with patient’s permission, shares the experiences of other patients to assist those with similar symptoms. Below is a recent patient’s story: K.O., his patient, came to Dr. Liao and his team for her cleaning after a year’s absence. This is their ChairSide chat:
DFL: “How are your teeth doing?”
KO: “No big problems. All is under control.”
DFL: “Nice to hear, Next, how’s your health? Any problem you wish you did not have to live with day after day?”
KO: “I am 40 pounds overweight, and I feel like I am missing a battery. I am motivated to do everything, but can only do one thing! I wake up refreshed maybe once a week, and my son says “I snore” when we went on a trip together. I eat very little and still gain weight — “It’s not my diet. I wish I could go for a walk with my husband but I am so exhausted all the time, I just can’t.”
KO’s baseline history includes:
- Bleeding gums
- Food traps in ULQ
- Teeth Grinding – “Big Time”
- Poor digestion
- Sleeps poorly
- Wakes up tired
- Low thyroid properly supplemented
- History of amalgam revision 8 years ago with sauna and Vitamin C, which “helped make me felt better but still not feeling well.”
- History of Lyme Disease – now gone
- Teeth crowded again despite braces in high school
DFL: K.O. is clearly trying but frustrated with her outcome. Medically, she is well-managed for her thyroid and Lyme disease. Oral-Systemically, Dr. Liao can see the airway as her number one issue, and stress as number two.
Oral-Systemic Links (OSA)
”… caniofacial abnormalities play significant roles in the pathogenesis of OSA in Malay patients,” concludes a 2011 study published in European Journal of Orthodontics (1). It is found in the following OSA patients:
- Larger neck and Body Mass Index (BMI, an indicator of obesity if > 25 kg/m2)
- Thicker tongue and longer soft palate
- Narrower airway spaces
I find the same to be true in American patients in my office just about every day.
“Excess weight is a well-established predictor of sleep-disordered breathing (SDB), which true across the world: US, Australia, Europe, and Asia (2). Among its findings:
Color Scale of Severity:
White – Blue: adequate airway
Green – Yellow: hazardous airway
Orange – Red: dangerous airway
Black: dire straits
- As Body Mass Index (BMI) and neck size goes up, so does the prevalence of Sleep Disordered Breathing (SDB, defined as AHI > 5 from sleep test)
- 41% of adults with mild SBD have excess weight (BMI > 25)
- 58% of adults with moderate-severe SBD (AHI > 15) have excess weight (2)
There is a greater risk for Sleep-related Breathing Disorders coming from living and sleeping with excess weight. Later, a 2008 study confirms:
- Obesity is probably the most important risk factor for the development of OSA
- 60–90% of adults with OSA are overweight
- Relative risk of OSA in obesity (BMI >29 kg/m2) is ≥10 times
- “Thus, it appears that obesity and OSA form a vicious cycle where each results in worsening of the other.” (3)
Weight gain is simple and complex at the same time. How and when does it start? Once you have K.O’s issues, how can you reverse the vicious cycle?
Holistic Mouth Recommendations
- Epworth Sleepiness Scale to assess Excessive Daytime Sleepiness (EDS)
- CBCT Imaging to evaluate cranial-facial abnormalities
- Clinical photos of her oral-facial-postural status
- Cranial-Facial Analysis
- Sleep Test as needed
- Refer to own physician for thyroid evaluation
- Consultation on treatment options
- Begin exercise once oxygen debt is paid down sufficiently
Clinical Findings
- Tongue posture is a clinical indicator of OSA risk (4)
- Tooth prints on sides of tongue is 70% specific for one of the criteria for OSA and correlates with poorer sleep efficiency. (5)
- Tongue swelling may indicate thyroid disorder (6, 7)
- Tongue Tie contributes to the relapse of her orthodontic (braces) treatment.
My Points: These are based on my clinical experience from listening to patient feedback after carrying out Whole Health recommendations. My Points do not constitute proof that I am right, nor am I offering medical advice with them. They are offered for consideration by you, your dentists and doctors, and for future studies to prove them right or wrong.
- Apple-shaped belly is connected to Impaired Mouth through Sleep-related Breathing Disorder, not by diet alone.
- Retruded (opposite of protruded) spells airway troubles, as mentioned in Impaired Mouth Syndrome discussion.
- A common oral-facial sign of an Impaired Mouth is Lack of upper lip support in profile. Flat upper lip that drops straight down on side view, usually indicates a retruded upper jaw and teeth, which usually spells airway troubles.
- Have K.O.’s doctors picked up on her sleep related breathing disorder?
- ChairSide chats in a dental office are an effective place to screen for SBD and control OSA-Obesity vicious cycle early.
Upper Jaw is too narrow by 5 mm in the front and 3 mm in the molars.
Lower jaw of is too narrow by 1 mm in the front and too wide by 3 mm in the molars.
References:
1. Albajanlan OA, et. al, Eur J Orthod (2011) 33 (5): 509-514.)
2. Young T, Peppard PE, Taheri S. Excess weight and sleep- disordered breathing. J. Appl. Physiol. 2005; 99: 1592–9.
3. Pillar G., et al, Diabetes Care February 2008 vol. 31 no. Supplement 2 S303-S309.
4. Barcelo X, et al, Oropharyngeal Examination To Predict Sleep Apnea Severity, Arch Otolaryngol Head Neck Surg. 2011;137(10):990-996.
5. Weiss et al, Archives of Otolaryngology, Head & Neck Surgery 2005:133(6)966-71
6. Shalu C & Manish B, Oral Manifestations of Thyroid Disorders and Its Management. Indian J Endocrinol Metab. Jul 2011; 15(Suppl2): S113–S116. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169868/
7. Huber MA, Terezhaimy GT, Risk Stratification and Dental Management of the Patient With Thyroid Dysfunction. Quintessence Int. 2008 Feb;39(2):139-50. http://www.ncbi.nlm.nih.gov/pubmed/18560652