The History of OSA / SDB.
The history of sleep medicine is a fascinating one, and that of obstructive sleep apnea no less! From its suspicion less than 200 years ago to a multi-billion industry and acceptance of epidemic proportions today – with no end in sight as the cases increase year by year, largely unrecognized, undiagnosed and poorly treated.
OSA has been termed the Pickwickian syndrome, and clinically known as obesity hypoventilation syndrome (OHS), after Charles Dickens (an astute observer of man) described one of his characters as having it.
Joe from the 1836 Charles Dickens novel, ‘The Pickwick Papers’, had many of the symptoms later described by clinicians when they discovered the condition of OSA such as obesity, lack of energy, snoring, constantly eating and falling almost on his feet.
The term is generally ascribed to William Osler the famous Canadian physician who termed the collection of findings as the “Pickwickian Syndrome”.
It was not until the famous French Surgeon Pierre Robin recognised the benefit of moving the lower jaw forwards in children so affected with a deficient lower jaw that the case started to be made for oral appliances.
It was then Colin Sullivan who developed the first Continuous Positive Airway Pressure which acted as a “pneumatic stent” to open the airway, as an oral appliance to hold the lower jaw forward may be considered a “mechanical stent” both are examples of OSA and SDB management.
Who can diagnoseSleep Disordered Breathing (SDB)?
Here’s the rub. Only a physician can diagnose sleep disordered breathing disorders. Many alas either don’t have the time or knowledge to screen , diagnose, treat or manage.
Consequently, (in Canada as well as some other countries) the patient is referred to a commercial concern. As such, many are there to sell an approach to management.
Remember, dentists can’t diagnose obstructive sleep apnea.
Dentists can only screen and refer to a physician, they can follow up with management only under prescription, but they are not allowed by law to diagnose.
In my opinion the dentist should be able to screen, ‘suspect’, test and then confer with the physician – before making an appliance (if appropriate) under prescription – or refer on if not appropriate.
To have such an unnecessary bottle neck when there are an estimated 22M undiagnosed OSA sufferers in the US and 5.4 M in Canada borders on irresponsibility in the name of monopolization.
You can however use an oximeter yourself as a back up. There are several excellent makes and models.
Do I have treatment options?
Now you know what to look for, what the problem is and how it’s measured to give a diagnosis, alas, outside in the real world you will often not be provided any information, or worse still only that based on “provider profitability”.