Sleep Medicine for Dentists: An Evidence-Based Overview

SLEEPMEDICINEFOR DENTISTSAN EVIDENCE-BASED OVERVIEW
Edited byGilles J. Lavigne, dmd, phd, frcd(c), hc, facd, fcahs, oc (cm)ProfessorCanada Research Chair on Pain, Sleep, and TraumaFaculty of Dental MedicineUniversité de MontréalClinical Research ScientistCenter for Advanced Research in Sleep and Trauma UnitSacred Heart Hospital (CIUSSS North Island)Montréal, QuébecPeter A. Cistulli, md, phd, mba, fracp, fccp, atsfProfessorResMed Chair in Sleep MedicineCharles Perkins CentreFaculty of Medicine and HealthUniversity of SydneyDirector of the Centre for Sleep Hea
CHAPTER 1 The Nature and Structure of Sleep
	Cibele Dal FabbroMonica L. AndersenGilles J. Lavigne
	Sleep-Wake Cycle
	Homeostatic process
	Circadian rhythm
	Sleep Recordings and Sleep Arousal
	Developmental Changes in Sleep-WakePatterns
	Sleep and Health
	Cost of Inadequate Sleep
	Conclusion and Advice
CHAPTER 2 Sleep Neurobiology
	Florin AmzicaGilles J. LavigneBarry J. SessleFlorian Chouchou
	Structures Involved in the Genesis of Sleep
	Sleep Homeostasis and Circadian Regulation
	Electrophysiologic Correlates of Sleep
	Wakefulness
	Sleep
	Cellular Activities During Sleep
	Functional Role of Sleep
CHAPTER 3 A Dental Perspective on the Classification of Sleep Disorders
	Raphaël C. HeinzerPeter A. CistulliAlberto Herrero BabiloniGilles J. Lavigne
	Sound-Related Complaints
		Snoring
		Sleep apnea-hypopnea
		Sleep bruxism
		Other conditions
	Movement-Related Disorders
		Restless leg syndrome and periodic limbmovement disorder
		Sleep bruxism
		Faciomandibular myoclonus and/or toothtapping
		REM behavior disorder
		Abnormal swallowing and choking
	Other Sleep-Related Conditions
		Insomnia
		Fibromyalgia
CHAPTER 4 Role of Dentists in Sleep Medicine
	Gilles J. LavigneRaphaël C. HeinzerCibele Dal FabbroMichael T. SmithJean-Franc˛ois MasseFernanda R. AlmeidaTakafumi KatoFrank LobbezooPeter A. Cistulli
	Interdisciplinary and Intersectoral TeamEffort
	Expertise of Dentists
	Comorbidity
	Dental Sleep Curricula
CHAPTER 5 Overview of Guidelines/Protocols for SDB
	Galit AlmozninoRafael BenolielFrank LobbezooLuc Gauthier
	The Role of Dentists in Screening andManaging SDB and OSA
	Multidisciplinary Management of SDBand OSA
	Dental Credentials/Certification
	Consultation and Patient Education
	Indications for OAT
		First-line therapy option
		Second-line therapy option
	Contraindications for OAT
	Informed Consent
	Monitoring Patients with OAs
CHAPTER 6 Sleep-Related Breathing Disorders
	Joseph M. DuncanAndrew S.L. ChanRichard W.W. LeePeter A. Cistulli
	Obstructive Sleep Apnea
		Risk factors and consequences
		Diagnosis and management
	Central Sleep Apnea
		Risk factors and consequences
		Diagnosis and management
	Sleep-Related Hypoventilation
		Risk factors and consequences
		Diagnosis and management
CHAPTER 7 Pathophysiology of OSA
	Danny J. Eckert
	Overview of Upper Airway Anatomy,Function, and the Propensity for Collapsein OSA
	Anatomical Contributors to OSA
	Nonanatomical Contributors to OSA
		Upper airway muscles
		Respiratory arousal threshold and ventilatorycontrol
CHAPTER 8 Mouth Breathing, Dentofacial Morphology, and SDB
	Stacey D. QuoBenjamin PliskaNelly Huynh
	Concepts of Facial Growth andDevelopment
	Consequences of Mouth Breathing
		Oral cavity
		Maxillofacial growth
		Masticatory function
		Nasal reflexes
		Lower airway
	Dentofacial Morphology Associated withSDB
		Children
		Adults
CHAPTER 9 Long-Term Consequences of OSA
	Frédéric Gagnadoux
	Sleepiness, Attention, Mood, and Qualityof Life
	Motor Vehicle Accidents
	Cardiovascular and MetabolicConsequences
		OSA and systemic hypertension
		OSA and metabolic disorders
		OSA and cardiovascular diseases
	OSA and Cancer: A Novel Association
CHAPTER 10 Periodontal Diseases and OSA
	Maria Clotilde CarraJoerg EberhardPeter A. Cistulli
	Periodontitis and Other Systemic Diseases
	The Association BetweenPeriodontal Diseases and OSA
	The Impact of Tooth Loss on OSA
	Possible Mechanisms Explaining theRelationship Between Periodontal Diseasesand OSA
	The Comorbidity of Periodontitis and OSA:Implications for Treatment
CHAPTER 11 Clinical Approaches to Diagnosis of Adult OSA
	Anna M. MohammadiehRichard W. W. LeeAndrew S. L. Chan
	Symptoms of OSA
		Symptoms during sleep
		Symptoms during wakefulness
	Physical Examination
		Craniofacial and airway features
		Obesity
	Comorbidities
	Questionnaires
	Diagnostic Tests
		Polysomnography
		Limited-channel sleep studies
CHAPTER 12 Imaging in OSA
	Kate SutherlandRichard J. SchwabLynne E. Bilston
	Upper Airway Imaging Modalities
		Cephalometry
		Computed tomography
		Magnetic resonance imaging
		Ultrasonography
		Nasopharyngoscopy
		Acoustic reflection pharyngometry
	Imaging Characteristics of OSA
		Upper airway volume
		Craniofacial structure
		Upper airway soft tissues
	Upper Airway Imaging as a Tool in TherapySelection
	Imaging and Incidental Findings
CHAPTER 13 An Overview of OSA Treatment in Adults
	Jesse W. MindelRyan DonaldUlysses J. Magalang
	General Guidelines
	Treatment Decision-Making
	First-Line Therapies
		Positive airway pressure
		Oral appliance therapy
	Alternative Therapies
		Positional therapy
		Upper airway surgery
		Bariatric surgery
		Hypoglossal nerve stimulation
	Adjunctive Therapy
	Emerging Concepts in OSA Treatment
CHAPTER 14 Diagnosis and Management of Pediatrick OSA
	Dimple GoelDominic A. Fitzgerald
	Diagnosis of OSA in Children
		Clinical tools for diagnosis
		Audio and video recording
		Abbreviated PSG
	Treatment of OSA in Children
		Adenotonsillectomy
		PAP therapy
		Anti-inflammatory medication
		Obesity and weight loss
		Craniofacial morphology and orthodontictreatment
CHAPTER 15 Orofacial Orthopedic Treatment
	Stacey D. QuoBenjamin PliskaNelly Huynh
	Management
		Screening
		Nasomaxillary widening
		Nasomaxillary lengthening
		The switch from oral to nasal breathing
		Muscle rehabilitation
CHAPTER 16 Oral Appliance Therapy
	Fernanda R. Almeida Kate Sutherland Peter A. Cistulli
	Mechanism of Action
	Clinical Outcomes
		Efficacy
		Comparison to CPAP treatment
		Side effects
	Clinical Protocol for MAD Therapy
		Multidisciplinary approach
		Indications and contraindications
		Initial dental assessment
		Appliance selection
		Follow-up
	Combination Therapy
CHAPTER 17 Upper Airway Surgical Management of OSA
	Leon KitipornchaiStuart G. MacKay
	Philosophy of OSA Surgery
	Comprehensive Clinical Assessment
	Nasal Surgical Options
	Velopharyngeal Surgical Options
	Retrolingual Surgical Options
	Bony Framework Surgical Options
	Alternative Surgical Options
	Complications
	Outcomes
CHAPTER 18 Emerging Therapies for OSA
	Olivier M. Vanderveken
	Potential Drugs for OSA Treatment
	Positional Therapy for OSA
		Transcranial magnetic stimulation
		Upper airway stimulation
CHAPTER 19 Risks of Anesthesia in Patients with OSA
	David R. Hillman
	Upper Airway Muscle Relaxation DuringSleep and Anesthesia
	Shared Predispositions to VentilatoryCompromise During Sleep and Anesthesia
	The Difficult Airway
	Shared Predispositions to Upper AirwayObstruction During Sleep and Anesthesia
	OSA and Perioperative Risk
	Perioperative Management of Known orSuspected OSA
		Identifying OSA preoperatively
		Where possible OSA has not been diagnosed
		Where OSA has been diagnosed and thepatient is compliant with PAP therapy
		Where OSA has been diagnosed and thepatient is not compliant with PAP therapy
		Avoidance of sedative premedication
		Anesthetic technique
		Postoperative nursing environment
		Postdischarge management
CHAPTER 20 Myofunctional Therapy for OSA
	Wen-Yang LiJean-François MasseFrédéric Sériès
	Physiologic Basis of OMT
	Efficacy of OMT
	Future Practice of OMT
	OMT in the Treatment of OSA
CHAPTER 21 Precision Medicine Approaches for OSA
	Kate SutherlandPeter A. Cistulli
	OSA Heterogeneity
	Systems Approaches to Precision Medicine
		Tools and resources available to OSAresearch
	Inroads in OSA
CHAPTER 22 Genetics of SDB
	Sutapa MukherjeeLyle J. Palmer
	Biomarkers of OSA
	Analytic Approaches to Detect Genesfor OSA
	The Genetic Epidemiology of OSA andAssociated Traits
		Heritability studies of OSA phenotypes
		Genome-wide linkage studies of OSAphenotypes
		Candidate-gene association studies of OSAphenotypes
		GWAS of OSA phenotypes
		Genetics of intermediate phenotypes for OSA
	New Approaches to Understanding OSA
CHAPTER 23 Definitions, Epidemiology, and Etiology of SB
	Frank LobbezooJari AhlbergDaniel A. PaesaniGhizlane Aarab
	Definition
		Sleep medicine
		Orofacial pain
		Prosthodontics
		The International Bruxism Consensus Group
	Epidemiology
	Etiology
CHAPTER 24 Clinical Approaches to Diagnosis of SB
	Kiyoshi KoyanoYoshihiro TsukiyamaPeter Wetselaar
	Questionnaires
	Clinical Examination
	Intraoral Devices and Recording Systems
		Intraoral device
		Recording systems
		Polysomnography
CHAPTER 25 SB as a Comorbid Condition of Other Sleep-related Disorders
	Ghizlane AarabRamesh BalasubramaniamMilton Maluly FilhoGilles J. Lavigne
	SB and OSA
	SB and Restless Leg Syndrome/PLMD
	SB and Insomnia
	SB and RBD
	SB and Epilepsy
	SB and Sleep-related GERD
	SB and Morning Headache
	SB and Other Sleep-related Disorders
CHAPTER 26 Physiologic Mechanisms Associated with SB Genesis
	Takafumi KatoKazuo OkuraGuido M. MacalusoGilles J. Lavigne
	Recognition of SB-RMMA fromSleep Recordings
		Sound
	Basic Physiology of the Genesis ofOromotor Activity
	Mechanisms in the Genesis of SB-RMMA
		Sleep oromotor activities
		Sleep oromotor excitability
		The roles of neurochemical substances andendocrine system on SB-RMMA
		Genetic candidates
		Microarousal
CHAPTER 27 Psychosocial Factors in Sleep and Awake Bruxism and Other Oral Parafunctions
	Richard OhrbachSylvia D. KreibigAmbra Michelotti
	Terminology
	Psychosocial Factors Related to SB
	Psychosocial Factors Related to WOP
CHAPTER 28 Genetic and Environmental Factors in SB
	Kazuyoshi BabaYuka AbeSamar KhouryFrank Lobbezoo
	Heritability
	Twin Studies
	Familial Aggregation
	Study Limitations in Interpretation
	Genetic Studies
	Epigenetics
CHAPTER 29 Consequences of SB on the Dentition, Dental Restorations, and Implants and How to Mitigate Them
	Sandro PallaIven KlinebergMauro Farella
	The Problem
	Bruxism and the Dentition
		Occlusal trauma
		Tooth wear
		Tooth cracks and fracture
	Bruxism and Implants
	How to Mitigate the Consequences of SB
CHAPTER 30 Behavioral, Dental, Pharmacologic, and Alternative Management of SB
	Daniele ManfrediniCharles R. CarlsonEphraim WinocurFrank Lobbezoo
	Behavioral Treatment
	Dental Interventions
	Pharmacologic Therapy
		Potential mechanisms of action
		Other pharmacologic candidates
	Alternative Approaches to Manage SB
CHAPTER 31 SB in Children and Adolescents
	Nelly HuynhNaomi KadochChristian Guilleminault
	Epidemiology
	Pathophysiology
		Stress and psychosocial influences
		Findings in sleep
		Pharmacology/neurochemistry
		Genetics and familial predisposition
	Risk Factors
		Airway patency
	Diagnostic Evaluation
		Ambulatory and sleep laboratory monitoring
		Scoring and severity scale of SB
	Management
CHAPTER 32 Definition and Classification of Orofacial Pains
	Alberto Herrero BabiloniDonald R. Nixdorf
	Classification
		Disorders of dentoalveolar and associatedstructures
		Temporomandibular disorders
		Neuropathic pain
		Neurovascular pains
		Idiopathic pain
		Other orofacial pains
CHAPTER 33 Pathophysiologic Conceptualizations of the Transition from Acute to Chronic Pain
	Claudia M. CampbellRobert R. EdwardsJanelle E. Letzen
	Mechanisms of Nociception and Acute Pain
	Peripheral and Central Sensitization
	Descending Pain Modulatory Systems
	Future Directions and Conclusions
CHAPTER 34 Mechanisms Underlying the Interactions Between Sleep Deficiency and Pain
	Monika HaackNavil Sethna
	Potential Mechanisms of Interaction
		Opioidergic system
		Monoaminergic system
		HPA axis
		Immune system
		Melatonin system
		Endocannabinoid system
CHAPTER 35 Behavioral and Pharmacologic Approaches to Manage Chronic Pain Comorbid with Sleep Disturbances
	Monika HaackNavil Sethna
	Behavioral Approaches
	Pharmacologic Approaches
		Targeting sleep
		Targeting inflammation
	Interventional Approaches to Reduce Postoperative Pain
		Pharmacologic
		Behavioral
	Sleep-Disturbing Medications to be Considered in Pain Management
CHAPTER 36 Association and Putative Causality of Orofacial Pain Conditions and Sleep Disturbances
	Peter SvenssonLene Baad-HansenTaro ArimaAntoon De Laat
	Orofacial Pain Mechanisms
		Nociceptive pain
		Inflammatory pain
		Neuropathic pain
		Functional pain
	Orofacial Pain–Sleep Disturbance Associations
		Experimental studies
		Clinical studies
		TMDs and SB
		Burning mouth syndrome and persistent idiopathic facial pain
		Toothache
		Trigeminal neuralgia
		Headaches
CHAPTER 37 Sleep and Headache
	Scott MaddaloShuja RayazMichael T. SmithNauman Tariq
	Migraine and Sleep
		Assessing sleep in patients with migrainedisorder
		Pathophysiology of migraine headache inrelation to sleep
		Management of migraine headache inrelation to sleep
	Tension-type Headache and Sleep
		Pathophysiology of tension-type headache inrelation to sleep
		Management of tension-type headache inrelation to sleep
	Cluster Headache and Sleep
		Pathophysiology of cluster headache inrelation to sleep
		Management of cluster headache in relationto sleep
	Hypnic Headache
		Pathophysiology of hypnic headache inrelation to sleep
		Management of hypnic headache in relationto sleep
	Other Conditions That May Overlap withSleep-Related Headache
		SB and TMD
		Morning headache
		Headache in patients with traumatic braininjury
		Sudden, novel, and intense headache crisisduring sleep
		Headache and acute herpes zoster
		Exploding head syndrome
CHAPTER 38 Pharmacologic Management of Sleep-Pain Interactions
	Effects of Analgesics on Sleep
		Over-the-counter medications
		Antidepressants
		Antiepileptics
		Antipsychotics
		Antispasmodics and muscle relaxants
		Other agents
		Substances at risk of misuse, abuse, anddependency
CHAPTER 39 The Use and Risks of Opioids in the Management of Orofacial Pain
	Alberto Herrero BabiloniLéa Proulx-BéginGilles J. LavigneMarc O. Martel
	Opioids and Their Role in Pain Management
		Opioid misuse
		Opioid use disorder
		Opioid-induced sleep disturbances
		Opioid-induced hyperalgesia
	Risk Factors for Problematic Opioid Use
	The Role of Dentists in the Current OpioidCrisis
		Screening
	Recommendations for the Management ofOrofacial Pain
CHAPTER 40 Nonpharmacologic Management of Insomnia and Orofacial Pain
	Daniel WhibleyNicole K. Y. TangMichael T. Smith
	Sleep Disorders and TMDs in the DentalSetting
	Screening for Insomnia and Sleep Apnea
	Sleep Hygiene Education
	Cognitive Behavioral Therapy for Insomnia
		CBT-I efficacy and effectiveness
		Suitable candidates for CBT-I
	CBT for Sleep and Pain