When you ask your patients how they are, do they often complain about being tired? Do they have crowded teeth even after going through orthodontic treatment? Have they joked about their snoring? These are a few small signs that they could have obstructive sleep apnea (OSA) and have no idea. In fact, an estimated 80 percent of moderate or severe cases of the disorder remain undiagnosed and untreated.
OSA is a serious health condition that affects an estimated one billion people worldwide. On top of causing snoring and excessive sleepiness, a significant connection between sleep apnea and health problems also exists. From mental health to physical health, OSA is associated with worsened overall health and functioning in a variety of ways.
As a dentist, you can help make a dramatic difference in your patients’ lives by screening them for sleep apnea and providing them with the resources they need to get treatment. The first step to changing lives, expanding your treatment options, and upgrading your practice is to understand AHI scores and comprehensive sleep testing. Let’s dive into what AHI scores are, what they tell you about a patient’s health, and how you can help patients decrease their scores for better overall well-being.
What is an AHI score?
An apnea-hypopnea index (AHI) score is designed to define whether or not an individual suffers from apnea or hypopnea. Essentially, these breathing problems occur throughout the night and involve a pause or cessation in breathing for 10 seconds or longer. One’s AHI is based on how many times a patient experiences apnea or hypopnea throughout one night, divided by the hours of sleep they got.
The following is a breakdown of what each score means:
- Normal sleep: fewer than five events per hour
- Mild sleep apnea: five to 14 events per hour
- Moderate sleep apnea: 15 to 29 events per hour
- Severe sleep apnea: 30 or more events per hour
The AHI score is calculated during a sleep test. The most common of these is polysomnography, which traditionally takes place at a sleep disorders unit within a hospital or at a sleep center. Other options include home sleep tests, which can be taken in the comfort of a patient’s home and monitors their breathing throughout the night.
What can an AHI score tell you about someone’s general health?
An AHI score, while meant to measure the severity of a patient’s sleep apnea, may also inform you of some important things about an individual’s health. This is because obstructive sleep apnea (OSA) is associated with serious, chronic health conditions, such as the following:
- Heart disease
- High blood pressure
- And more
The truth is that OSA often comes with a number of comorbidities that can contribute to a patient’s worsening overall health. Let’s explore the connection between this sleep disorder and three areas of the body that can be affected by poor breathing and sleeping: heart health and mental health.
AHI Scores and Heart Health
Heart disease is the leading cause of death in the US. Several behaviors and risk factors can increase one’s risk of developing the disorder, and OSA may be one of them. According to recent studies, OSA prevalence can be as high as 40 to 80 percent in patients who have issues with their heart, including hypertension, heart failure, stroke, and coronary heart disease. For example, patients with severe sleep apnea are expected to be two to four times more likely to have abnormal heart rhythms. The longer an individual suffers from OSA without being diagnosed or treated, the higher their risk of developing another serious comorbid condition.
Another reason why many patients with OSA have heart disease may stem from one of their mutual causes: obesity. Obesity is one of the most common causes of sleep apnea, as well as heart disease. However, both obstructive sleep apnea and obesity have been shown to independently influence heart health. While losing weight may help patients improve symptoms associated with each of these conditions, it may not be enough to entirely treat the disorders.
AHI Scores and Mental Health
Sleep apnea can also take a significant toll on an individual’s mental health. Not only are people left exhausted in the morning, but they also get fragmented sleep at night after they finally lay their heads down to rest. It’s an endless cycle of sleep deprivation.
According to one study, individuals who reported past-year sleep apnea were over three times more likely to have depression, 2.75 times more likely to experience suicidal ideation, and almost four times more likely to have anxiety in comparison to those without sleep apnea. The longer a patient isn’t able to breathe and sleep well at night, the more likely their mental health is going to suffer.
AHI Scores and Everyday Functioning
On top of long-term physical and mental health concerns, poor sleep can lead to difficulty functioning every day. Many patients with OSA experience the following challenges:
- Difficulty concentrating on tasks
- Excessive daytime sleepiness that impairs functioning
- Memory problems
- Slower reaction times
- Irritability and moodiness
According to Harvard, obstructive sleep apnea can also have a significant impact on the family and friends of a patient. Patients are less likely to engage in social activities because they are too tired. They are also more likely to affect their partner’s sleep, which often causes them to sleep in separate bedrooms. Not only can this cause stress in a relationship, but it can also lead patients to feel even more isolated.
There are also safety risks that come along with OSA. People with the sleep disorder are up to 10 times more likely to be in a car accident, putting both themselves and others at risk. This can be especially challenging for commercial truck drivers, who must be alert at all times while driving for hours a day. Regardless of an individual’s career or interpersonal relationships, OSA can put a toll on their ability to function effectively every day and accomplish their goals.
What can an AHI score tell you about someone’s dental and airway health?
An AHI score can be indicative of your patient’s ability to breathe and sleep well at night. Believe it or not, this can also affect their oral health. This is why dentists are in such an excellent position to screen for OSA: Many of the physical signs of the disorder can manifest themselves in an individual’s mouth.
For example, many patients with OSA may experience the following:
- Crowded, crooked teeth
- Deep palate
- Mouth breathing
- Large neck circumference
- Small jaw
- Scalloped tongue
Along those lines, someone who has a high AHI score—and therefore sleep apnea—also likely has issues with their airway, as it could be obstructed by a variety of causes. For example, the muscles in the back of the throat may relax too much due to anatomical anomalies of the soft palate, uvula, tonsils, or tongue.
When someone has a high AHI score, it’s possible that their worsened sleep and breathing could also be contributing to other challenges—even those that may seem unrelated to sleep apnea. This is why it’s so important to screen patients for OSA and attain their AHI scores.
How can a patient lower their AHI score?
An AHI score can also be used in the long term to determine the efficacy of an OSA treatment. Because the score is a direct representation of the number of apneas a patient experiences in a given night, it can help determine whether the changes recommended to them have helped. However, keep in mind that minor fluctuations in AHI are normal.
Recommending the following lifestyle changes may also help a patient lower their AHI score:
- Changing sleep position
- Exercising regularly
- Abstaining from alcohol
- Ceasing smoking
- Developing a regular nighttime routine
- Eating a healthy diet
These healthy changes can help patients ensure that other variables that may affect their sleep and breathing aren’t inhibiting treatment.
As a dentist, you are in a powerful position to help your patients breathe and sleep better at night. You are the first line of defense against a lifetime of pain that could be worsened by sleep apnea symptoms. If you’d like to learn how to develop processes at your own dental practice to help your patients, expand treatment options, and drive revenue, visit thevivosinstitute.com or attend one of our upcoming events!