The Journal of the American Dental Association
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

J Am Dent Assoc, Vol 140, No 5, 536-542.
© 2009 American Dental Association
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Simmons, M. S.
Right arrow Articles by Clark, G. T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Simmons, M. S.
Right arrow Articles by Clark, G. T.

CLINICAL PRACTICE

JADA Continuing Education

The Potentially Harmful Medical Consequences of Untreated Sleep-Disordered Breathing

The Evidence Supporting Brain Damage



Michael S. Simmons, DMD and Glenn T. Clark, DDS, MS

Background. The authors conducted a literature review to evaluate whether current scientific evidence supports the fact that brain damage results from episodic hypoxia (EH) as seen during sleep-disordered breathing (SDB).

Types of Studies Reviewed. In their review, the authors included models that re-created circumstances seen in EH during SDB. They reviewed animal and human studies, including those with children and animal pups as subjects. These studies addressed neurocognitive and neurobehavioral effects, physical changes found on a cellular level as seen in brain imaging and the effects of treatment.

Results. The evidence suggests that EH as seen during SDB causes damage to the brain with specific areas of gray- and white-matter loss, alteration in autonomic and motor regulation, and damage to higher cognitive functions. While there is evidence of spontaneous reactive mechanisms, it is not clear if they limit ongoing brain damage or contribute to additional damage. Retention of deficits in the brain even after treatment suggests long-term injury.

Clinical Implications. Evidence shows that EH during SDB may cause permanent brain changes and can start early in the progression of sleep disorders even in childhood. SDB should be identified and treated early to reduce and possibly prevent brain damage and permanently decreased cognitive function. Dentists are in the unique position of being able to screen patients for SDB during periodic examinations while providing routine dental health care. When dentists catch SDB early in the progression and refer patients to and coordinate care with patients’ physicians, they can provide better service to their patients and may prolong and improve their patients’ quality of life.

Key Words: Sleep-disordered breathing; sleep apnea; snoring; episodic hypoxia; brain damage; cognitive changes

Abbreviations: AHI: Apnea hypopnea index. • CPAP: Continuous positive airway pressure. • EH: Episodic hypoxia. • fMRI: Functional magnetic resonance imaging. • MADs: Mandibular advancement devices. • MB: Mamillary body. • MRI: Magnetic resonance imaging. • OSA: Obstructive sleep apnea. • SDB: Sleep-disordered breathing. • UARS: Upper airway resistance syndrome.




This article has been cited by other articles:


Home page
 CirculationHome page
B. Riegel, D. K. Moser, S. D. Anker, L. J. Appel, S. B. Dunbar, K. L. Grady, M. Z. Gurvitz, E. P. Havranek, C. S. Lee, J. Lindenfeld, et al.
State of the Science: Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association
Circulation, September 22, 2009; 120(12): 1141 - 1163.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright©1995-2009 American Dental Association (ADA).
Reproduction or republication strictly prohibited without prior written permission of ADA.