Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Saturday, November 6, 2010


A new study in Chest shows significant changes in bone and teeth positio secondary to CPAP use. The changes are retropositioning of the upper maxillary teeth and the bones of the face. Smashed Face Syndrome resulting from long term CPAP use could have negative consequences of a cosmetic and physiologic nature.

It is important to note that treatment of sleep apnea is essential and that CPAP and Oral Appliances the only First Line treatments can cause changes. These changes should not be considered a reason to discontinue life-saving treatment with either modality.

The changes that occur with Oral Appliance treatment are not the same as changes that occur with CPAP use. There are ominous problems that could be associated with the CPAP specific changes. These changes could cause worsening of Sleep Apnea if CPAP use is discontinued and even lead to an addiction to CPAP. I have discussed problems with "CPAP Addiction" with Dr Alex Golbin a prominent sleep physician and pioneer of the field of Sleep Medicine.

The change that occured with use of CPAP include "Significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity" These findings were visible on cephalometric radiographs but were not reported by patients. All of these changes have the potential to cause TMJ problems, tension headaches and migraines. The changes CPAP cause will lead to retropositioning of the mandible. The changes caused by oral appliances are anterior positioning of the mandible. Studies have shown that these changes do not adversly affect the TM Joints (TMJ). In fact these are the same changes that take place when treating TMJ disorders with a neuromuscular orthotic. Part of the effect of neuromuscular treatment of headaches and migraines (see www.ihateheadaches.org) is thought to be do to improvements in airway and quality of sleep.

Dentists routinely explain to their patients that oral appliances can change bites and move teeth as part of their informed consent for treatment.

The responsibility for informing patients of negative orthopedic changes from CPAP falls on the prescribing physicians and on CPAP manufacturers. The FDA should make device manufcturers include information on this subject in their materials.

Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea.
Tsuda H, Almeida FR, Tsuda T, Moritsuchi Y, Lowe AA.

Department of Oral Health Sciences, The University of British Columbia, Vancouver, BC, Canada. htsuda@dent.kyushu-u.ac.jp
BACKGROUND: Many patients with obstructive sleep apnea (OSA) use nasal continuous positive airway pressure (nCPAP) as a first-line therapy. Previous studies have reported midfacial hypoplasia in children using nCPAP. The aim of this study is to assess the craniofacial changes in adult subjects with OSA after nCPAP use.

METHODS: Forty-six Japanese subjects who used nCPAP for a minimum of 2 years had both a baseline and a follow-up cephalometric radiograph taken. These two radiographs were analyzed, and changes in craniofacial structures were assessed. The cephalometric measurements evaluated were related to face height, interarch relationship, and tooth position.

RESULTS: Most of the patients with OSA were men (89.1%), and the mean baseline values for age, BMI, and apnea-hypopnea index (AHI) were 56.3 ± 13.4 years, 26.8 ± 5.6 kg/m(2), and 42.0 ± 18.6/h. The average duration of nCPAP use was 35.0 ± 6.7 months. After nCPAP use, cephalometric variables demonstrated a significant retrusion of the anterior maxilla, a decrease in maxillary-mandibular discrepancy, a setback of the supramentale and chin positions, a retroclination of maxillary incisors, and a decrease of convexity. However, significant correlations between the craniofacial changes, demographic variables, or the duration of nCPAP use could not be identified. None of the patients self-reported any permanent change of occlusion or facial profile.

CONCLUSION: The use of an nCPAP machine for > 2 years may change craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the dental arches.

PMID: 20616213 [PubMed - indexed for MEDLINE]

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posted by Dr Shapira at 6:11 AM