Lifestyle diseases are on the rise in the world especially in India where the proportion of the middle class is increasing manifold. Hypertension, cardiovascular diseases, diabetes, increased lipids are just to name a few. We hear about sudden cardiac arrests and related deaths irrespective of age and sex, very regularly nowadays; especially during sleep. It is also common to hear that these deaths are labelled as myocardial infarctions and that it is unfortunate! But, do you know that 75% of these “unfortunate” deaths could have been avoided if only he/she was diagnosed from a killer disease known as “OBSTRUCTIVE SLEEP APNEA (OSA)”. It is very commonly treated by sleep medicine specialists in the west in close collaboration with physicians and dentists. But here, in India, even the sleep physicians are finding it tough to get through to the patient due to the lack of awareness.
Now, what is OSA?
It is a self-explanatory term which describes the condition wherein the person is not able to breathe normally at sleep due to an obstruction of the airway. The upper airway occlusions comprise of the nasopharyngeal blockages like polyps, adenoids or deviated septum; oro-pharyngeal occlusions like macroglossia or posterior mandibular positioning; Velo-epiglotto-pharyngeal occlusions like tonsillitis or a long uvula or even a large neck circumference (increased BMI). All these press upon the airway, leaving the person gasping for air to breathe. The tongue (the genioglossus attached to the mandible) is almost always the biggest troublemaker.
During sleep when your body is at rest the mandible falls back pulling the tongue backwards. As the tongue falls back it vibrates hitting the small tongue(uvula) creating a snoring sound. Hence, the heart would need to pump more strenuously to inhale all the possible oxygen it can. This would lead to the heart muscle getting enlarged and tired. A typical patient can relate this to exertional dyspnoea which means he or she would feel breathless when they exert a little extra effort during a physical activity like climbing stairs. If this continues the patient would end up with possible cardiac arrest. Since oxygen is at a lower level and also because of the persisting airway block by the tongue the carbon dioxide level increases within the body. This leads to a situation called hypercapnia that is known as a desaturation event.
The brain senses this as a dangerous event and response by forcing the tongue to move forward. While moving forward the tongue pulls the lower jaw along with that forcing the subsequent clenching or Bruxism. Hence the sleep clenching/bruxism is virtually a physiological response of the human body to negate the ill-effect of OSA after sleep bruxism. This clenching would further deteriorate the TMJ due to the pressure exerted within the TMJ complex. Almost 80% suffer from OSA related clenching/bruxism which they are seldom aware of.