Sleep apnea considerations for the restorative patient
Over the next few weeks, though, I saw the patient for complaints of anterior tooth sensitivity. I saw the patient for several weeks of adjustments. Finally, I convinced the patient he must be clenching and made an occlusal guard for nighttime wear and occasional day use. He has a stressful job and thought that was causing the clenching. He tolerated the guard during the day, but never was able to sleep very well with the guard at night. He finally gave up using it, and we dealt with cold and biting sensitivity periodically.
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As my knowledge of sleep-related breathing disorders increased, I suspected he may have sleep apnea. Although he denied daytime fatigue, he reported loud and frequent snoring. He filled out a screening form for sleep-related breathing disorders and answered positive to some of the questions. He was sent to a sleep physician who performed an overnight polysomnogram (sleep study). The report from his sleep study showed severe sleep apnea. The patient is getting a continuous positive airway pressure (CPAP) machine.
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After this case, I make sure to perform a pre-prosthetic clinical checklist and comprehensive health history update that includes sleep disturbance screening.