Tuesday, November 2, 2010

CPAP and Facial Structure

In young children, who are still growing, using CPAP can alter the way their face grows because of the pressure of the mask on their face every night. Therefore, using CPAP in young children can be challenging.

In adults, their faces are done growing, so using CPAP shouldn't alter their facial structure...or so we thought.

A study was done in Japan on Japanese adults with obstructive sleep apnea who used CPAP. There were 46 patients who used CPAP with a nasal mask (one that fits over the nose like this) for at least 4 hours per day for at least five days a week for between 25 and 46 months. Facial structure was measured with special x-rays.

The researchers concluded that there was a statistically significant change in the upper jaw of these CPAP using patients. Specifically, the change was a slight pushing in of the front teeth and upper jaw. None of the patients noticed any of the changes in their face or jaw. It was only seen on the special x-rays. Also, there was no clinical significance (like difficulty eating) with the facial changes. Finally, this is a small study and from the report, I can't tell if the masks were all the same brand or how tight they were. These are important variables that affect the significance of these findings.

I think the spokesperson, Harry L. Legan, for the American Association for Orthodontics sums up what's going on with this study. Dr. Legan says "the sharp sleep doctor will consider having the patient evaluated by an orthodontist to see if they should wear an intraoral device to prevent untoward movements of the teeth while using nCPAP."

In other words, despite having no clinical significance or asthetic change from using CPAP, the orthodontists want us sleep doctors to have our patients see them for an oral appliance. That's what it boils down to. Orthodontists can't knock CPAP for it's far superior efficacy, so they have to drum up some very minor facial changes as the reason to use an oral appliance instead. I'm not buying it. I'll stick with what works - CPAP.

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