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Prescription Meds vs OSA

Prescription Meds vs OSA

Plus: AI's Impact on Sleep Diagnostics

December 18, 2023

Good morning. This is More Than Teeth. The newsletter that helps dental sleep professionals get 1% better every week.

Good morning!

Can prescription medications exacerbate sleep apnea?

Indeed, they can.

This issue spotlights the five major drug classes - benzodiazepines, opiates, muscle relaxants, testosterone, and medications inducing weight gain - and their negative impact on sleep apnea.

In today’s edition:

The reach of medications worsening OSA
What medications and how they affect OSA
Balancing medication needs and OSA treatment

Clinical Corner

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Key Takeaways🔑

Medication Impact on OSA: A significant number of Americans are prescribed medications like opioids, benzodiazepines, and muscle relaxants, which can worsen OSA.

Medication Categories and OSA: Various prescriptions, including opioids, benzodiazepines, and muscle relaxants, have differing effects on OSA severity.

Collaboration for OSA Management: Effective OSA management in patients on specific medications requires collaboration between dentists and physicians through referral systems and joint consultations.

1/ The Broad Reach of Medications Worsening OSA

The significant impact of certain prescription medications on the worsening of Obstructive Sleep Apnea (OSA). Over 200 million americans are effected by these prescribes medications annually! Understanding this impact is key for dental sleep professionals to provide comprehensive care. Let's look at the prevalence and implications of these medications.

Opioids: Opioids, a major concern in the realm of pain management, have a profound impact on sleep apnea. According to the Centers for Disease Control and Prevention (CDC), approximately 10.1 million people misused prescription opioids in the United States in 2020 (CDC Report). The depressant effects of opioids on the central nervous system make them a significant contributor to sleep-disordered breathing.

Benzodiazepines: Widely prescribed for conditions like anxiety and insomnia, benzodiazepines are used by a substantial portion of the population. The National Institute on Drug Abuse (NIDA) reported that about 5.4% of the U.S. population used benzodiazepines in 2018 (NIDA Report). These drugs can lower nocturnal oxygen saturation, a critical factor in managing OSA.

Muscle Relaxants (e.g., Baclofen): These medications, though less common than opioids and benzodiazepines, are still widely used for muscle spasms and spasticity. The exact numbers of patients on specific drugs like baclofen are harder to obtain, but their role in exacerbating OSA symptoms by relaxing throat muscles is clinically acknowledged.

Testosterone: Testosterone therapy, especially among middle-aged and older men, has seen an upsurge. A study in JAMA Internal Medicine highlighted that testosterone prescriptions in the U.S. tripled over a decade (JAMA Study). This therapy is linked to increased AHI and prolonged hypoxemia times in OSA.

Medications Inducing Weight Gain: A wide range of drugs, including some psychiatric medications, can lead to weight gain, a key risk factor for OSA. The CDC's report showing that 13.2% of U.S. adults used antidepressants during 2015–2018 (CDC Report) underscores the potential scale of this issue.

Conclusion

The widespread use of these medications suggests a substantial overlap with the OSA patient population. As dental sleep professionals, a deep understanding of these interactions is essential for optimal patient management. This awareness enables us to engage in more informed discussions with our patients and their medical providers, fostering a more integrated approach to OSA treatment.

2/ Medications That May Worsen OSA

it's paramount to understand how prescription medications can affect our patients with Obstructive Sleep Apnea (OSA). This edition of Clinical Corner reviews a comprehensive study that categorizes various medications based on their impact on OSA. Remember, a thorough medication history is not just a formality; it's a critical component of effective OSA management.

Opioids: Opioids, known for their CNS depressant effects, have been shown to induce sleep-disordered breathing, including a mix of obstructive apneas and central sleep apnea. The severity often correlates with dosage.

Benzodiazepines: Recent studies show that while some benzodiazepines don't significantly alter AHI, they can lower nocturnal oxygen saturation, which is a concern in OSA management.

Myorelaxants (Baclofen): Baclofen, often used as a muscle relaxant, can worsen OSA by causing upper airway collapse and depressing respiratory drive during sleep.

Testosterone: Testosterone therapy has been linked to increased AHI and prolonged hypoxemia times, particularly in men with no prior history of sleep apnea.

Drugs Inducing Weight Gain: Medications like certain antipsychotics, antidepressants, and antidiabetics, known to cause weight gain, can exacerbate or even induce OSA due to the close relationship between obesity and sleep apnea.

3/ Navigating the Intersection of Medications and OSA

In the realm of dental sleep medicine, managing medications that negatively affect Obstructive Sleep Apnea (OSA) falls outside the direct scope of a dentist. However, this challenge underscores the importance of collaboration with physicians. This partnership is essential for ensuring our patients receive comprehensive care that addresses both their OSA and the broader aspects of their health influenced by medication.

Strategies for Collaborating with Physicians

Effective Communication:

Direct Referrals: Establish a referral system where you can directly refer patients to sleep specialists for medication assessment.
Joint Consultations: Consider scheduling joint consultations with physicians for complex cases, enabling a multidisciplinary approach to patient care.
Regular Updates: Keep an open line for regular updates and discussions about patient progress and response to OSA treatments.

Educational Exchange:

Sharing Knowledge: Educate physicians about the nuances of dental sleep medicine and learn from their expertise in medication management.
Case Studies: Share anonymized case studies that highlight the impact of certain medications on OSA treatment outcomes.

Building a Network:

Professional Associations: Engage with local and national professional bodies to expand your network of physicians familiar with OSA.
Community Outreach: Participate in community health forums or seminars to foster relationships with healthcare providers in your area.

Managing Patient Expectations and Treatment Efficacy

In managing patient expectations and treatment efficacy, a key aspect is thorough patient education. It's important to ensure that patients are well-informed about how certain medications can impact their OSA treatment. This involves setting realistic expectations about the potential efficacy of OSA treatments, especially when patients are on medications that may hinder their progress in managing sleep apnea.

Alongside this, it's vital to implement a system of regular assessments. These frequent check-ins are essential to monitor the efficacy of OSA treatments and provide an opportunity to discuss any necessary adjustments with the patient's physician. As dental sleep professionals, we should also be prepared to adapt our treatment plans for OSA in response to any changes in the patient's medication regimen.

Conclusion

While dentists may not directly manage medications that adversely affect OSA, they play a pivotal role in a collaborative care model. Through effective communication with physicians, educational exchange, and robust patient education, we can ensure our patients are fully aware of the potential side effects of their medications on OSA treatment. This collaborative approach is key to providing holistic care and optimizing treatment outcomes for our patients with OSA.

Business of Sleep

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AI’s impact in DSM

In the world of healthcare, something exciting is happening – Artificial Intelligence (AI) is making a big splash. Think of AI as a super-smart helper in diagnosing and treating various health issues, including sleep problems like Obstructive Sleep Apnea (OSA).

Now, you might wonder, how does this all tie into dentistry? It's quite fascinating. Usually, when you visit the dentist, you fill out forms that ask about your sleep. These questions are not just routine; they're crucial in spotting signs of sleep issues like OSA.

Here's where AI becomes a game-changer. Advanced AI tools used by websites like sleeptest.com, sleepimage.com, or isleepmds.com are helping dentists figure out if you're at risk for OSA. They use a ton of data to make smart guesses about your sleep health, much more than a human could process.

If your dentist thinks you might have OSA, they can use these AI tools to arrange a sleep test for you at home. After you take the test, AI analyzes your sleep data and a medical expert reviews the results. This combo of AI smarts and human expertise makes the whole process faster and more reliable.

So, why is AI such a big deal in this process? Well, it's super accurate. It can pick up on sleep patterns and issues that might be missed otherwise. This means you get a more precise diagnosis and, consequently, better treatment.

In short, AI is helping dentists play a crucial role in managing sleep issues like OSA. By teaming up with AI, dentists are not just looking after your teeth; they're also helping you get a good night's sleep, which is essential for your overall health.