An expert in sleep medicine offers guidance for treating OSA

Anisha Hall Hoppe, Dental Tribune International

Fri. 19. April 2024

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Combining her expertise in both oral and maxillofacial surgery with sleep medicine, Dr Mei Hui Tan’s presentation at IDEM 2024 offered clinicians the chance to better understand the signs and symptoms of obstructive sleep apnoea (OSA) and tools for identifying appropriate treatment options. Prior to her presentation, Dental Tribune International spoke with Dr Tan, who holds leadership, consultant and lecturing positions at some of the foremost institutions in Singapore, about what dental surgeons, in particular, could look forward to in the lecture.

Dr Mei Hui Tan. (Image: Koelnmesse)

Dr Tan, with your extensive background in oral and maxillofacial surgery and your current roles as a consultant and director of medical and academic organisations, how do you integrate your expertise in orthognathic surgery and facial aesthetics into the management and treatment of OSA?
One of the main risk factors for OSA is craniofacial restriction. For OSA patients with craniofacial restriction, maxillomandibular advancement (MMA) surgery would be able to correct the underlying cause of OSA, thereby successfully managing their OSA to improve their quality of sleep and life. With careful consideration of the patient’s facial features and the armamentarium of various osteotomy techniques available in orthognathic surgery, I am able to customise the MMA surgery for OSA patients in order to optimise treatment success as well as to achieve a balanced facial appearance for the patient.

Given the low level of awareness and knowledge of OSA among the general population in Singapore, what strategies do you believe dental surgeons should employ to improve early identification and referral of suspected cases of OSA?
Dental surgeons have an important role to play in identifying patients at risk of OSA, as they are trained in the evaluation of craniofacial restriction, which is a major risk factor for OSA. Furthermore, dental surgeons are able to identify intra-oral features such as narrow and high-arched palate and large torus mandibularis, as well as bruxism, which are often associated with OSA. When patients present with such findings, the dental surgeon should administer the STOP-BANG questionnaire and refer those at moderate to severe risk for a sleep study.

“Dental surgeons have an important role to play in identifying patients at risk of OSA, as they are trained in the evaluation of craniofacial restriction, which is a major risk factor.”

In your presentation, you will be talking about various treatment options for OSA, ranging from conservative treatments to surgical interventions. Could you share one or two of these tailored treatment options?
Continuous positive airway pressure (CPAP) remains the gold standard treatment for OSA because of its high efficacy; however, it requires lifelong use, and many patients are unable to tolerate it. For patients who prefer an alternative conservative treatment, mandibular advancement devices remain the next best option after CPAP. Younger patients who may not want to use CPAP for decades may seek surgical alternatives to manage their OSA.

For patients who present with craniofacial restrictions contributing to OSA, MMA surgery is an appropriate treatment, as correcting the skeletal framework helps advance the pharyngeal tissue and tongue, thereby improving the posterior airway space. Every patient will vary in his or her risk factors for OSA, and clinical examination, together with nasal endoscopy, will help identify the causes of obstruction. Ultimately, we need to take into consideration each patient’s preferences and ensure that follow-up sleep testing is done to ensure treatment success.

“Dental professionals will continue to play an important role in diagnosis and in appropriately referring patients for treatment.”

With the advancements in sleep studies and diagnostic tools, how do you see the future of OSA management developing, particularly in the context of oral and maxillofacial surgery, and what role do you envision dental professionals playing in this evolving landscape?
With more and more home sleep studies available in the market and with increasing accuracy of the devices available, there will be better diagnosis and hence earlier treatment for patients with OSA. Already, we are starting to see more people in their 20s getting diagnosed with OSA. Dental professionals will continue to play an important role in diagnosis and in appropriately referring patients for treatment. Those who are interested in sleep medicine can go for further training to equip themselves with the knowledge and skills to manage OSA patients. OSA is pushing more patients to seek corrective skeletal MMA surgery, and oral and maxillofacial surgeons will play a key role in providing a good surgical alternative for patients.

Do you have anything else you would like to add?
Good sleep is a very important aspect of health, and I hope that, with increasing awareness of OSA, patients will be diagnosed and treated early to reduce the risks of medical comorbidities and the overall health burden in our population.

Editorial note:

During the scientific conference at IDEM Singapore 2024, Dr Tan lectured on “Identifying obstructive sleep apnoea suspects and the management of obstructive sleep apnoea” on 19 April from 17:00 to 18:00.