Apnoea-hypopnoea syndrome (SAHS) and orthodontics

What is sleep apnoea-hypopnoea syndrome?

The sleep apnoea-hypopnoea syndrome (SAHS) is a fairly common condition in the general population that consists of a complete (apnoea) or partial (hypoapnoea) interruption of airflow during sleep due to upper airway obstruction. It can cause transient micro-awakenings accompanied by snoring, leading to other symptoms and consequences such as drowsiness, insomnia, headaches and irritability or urinary incontinence in younger sufferers, among others.

One of the problems with SAHS is the difficulty associated with early detection, which would - as with many other diseases - improve the success of treatment. Relying on a medical history and a clinical and physical examination in a consultation room is a rather poor method of diagnosing sleep apnoea-hypopnoea syndrome, even for specialists in the field. In reality, the ideal method of detecting whether a patient is suffering from a severe case of the syndrome would be through a very specific test known as the polysomnography.

A polysomnography is a test indicated for the study of different sleep disorders that is performed during the night, when the patient sleeps, and which consists of recording brain activity, breathing, heart rate, muscle activity and blood oxygen levels while sleeping. Obviously the time, effort and cost of such a procedure make it difficult for the general population to perform.

Example of polysomnography.

The role of the orthodontist in SAHS

The role of the orthodontist plays a very relevant role in the early detection of SAHS, because through anamnesis, clinical examination and cephalometric analysis it is possible to evaluate, compare and detect the anatomical characteristics and symptoms that are associated with the syndrome and that can be accompanied by mandibular retrognathism or Class II malocclusion with mandibular protraction, which sometimes makes it possible for patients seeking orthodontic treatment to end up in the orthodontist's office and thus detect SAHS.

If detected, the professional can improve the patient's situation and will also refer the patient to an ear, nose and throat specialist for a multidisciplinary treatment plan.

If the patient is a growing child, orthodontists can act by means of orthopaedic treatment, using a series of intraoral appliances that will help us to solve the problem of upper airway obstruction.

For example, in children with mandibular retrognathism, we can use jaw advancement devices to move the mandible into a more forward position, thereby increasing the size of the upper airway and relieving its obstruction. These appliances come in fixed or removable versions, the use of which will depend on the diagnosis and treatment plan considered indicated for the patient's specific case. At Vélez y Lozano we have both options available.

In other cases we may find maxillary compression, with a prevalence of mouth breathing as opposed to nasal breathing, which is quite typical in patients with SASH. In these cases, what we carry out is a disjuncture treatment of the palatal suture, thus increasing the width of the maxilla, which favours the recovery of nasal breathing.

Palatal circuit breaker.

It is of vital importance to further improve diagnostic criteria in order to be able to act earlier and more effectively in the affected paediatric population.