March 2018

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The important Role of the ORthodontist in Sleep Medicine

December 2018

New findings on the negative repercussions of Sleep Apnea have increased the attention given to sleep disorders in both children and adults. A multidisciplinary approach to Sleep Medicine has evolved in order to best address this multifactorial disorder that has life threatening ramifications. The Orthodontist has become an integral member of the Sleep Medicine team in treating both Child Obstructive Sleep Apnea and Adult Sleep Apnea.

A study at Johns Hopkins University showed that sleep deprived children score an average of 15 points lower on IQ tests. This deficit has been shown to be reversible when the things that caused the obstruction (that led to the sleep deprivation) are changed. Constriction of the upper jaw is one of the factors that causes sleep obstruction - thus sleep deprivation - that leads to lower IQ scored in children. And Orthodontists have been successfully diagnosing and treating the other anatomical mal-relationships that are associated with Obstructive Sleep Apnea in children, including mandibular retrognathia, maxillary retrusion, and vertical dimension deficits. 

For years, adults diagnosed with Obstructive Sleep Apnea have been forced to utilize a C-PAP machine, which is a forced respiration apparatus that is very uncomfortable. Studies have shown that less than 20% of all patients diagnosed with severe OSA have been able to successfully wear the C-PAP mask. New Sleep Apnea Orthotic Appliances have been found to be very successful if properly fabricated and utilized.  These appliances have been fabricated and delivered by Orthodontists for many years as part of orthodontic treatment, and an Orthodontist is the specialty most experienced in the design, fabrication and follow-up for successful Sleep Apnea Appliance therapy. Initial individual diagnosis as to the causative factors is paramount to successful treatment with a sleep appliance, and a multidisciplinary approach to treatment, including an orthodontist trained in Sleep Medicine is an integral member of the treatment team.

Drs. Griffin and Errera have had extensive additional training in Sleep Medicine and are affiliated with a multidisciplinary team for the treatment of Obstructive Sleep Apnea. In addition, Dr. Griffin has lectured on Obstructive Sleep Apnea diagnosis and treatment as a faculty member in the Department of Orthodontics at The Harvard University School of Dental Medicine.  

FAUQUIER TIMES Features Dr. Al Griffin

November 29, 2017

"Dr. Al Griffin. Taking a team approach to tackle obstructive sleep apnea." By Leonard Shapiro. 

Warrenton Orthodontist Al Griffin has treated patients in Loudoun, Culpeper and Fauquier counties since 1983. But a conversation with pediatrician and friend Dr. Joshua Jakum a half-dozen years ago about the similarities of symptoms of sleep apnea in children and the symptoms of children constantly referred to pediatricians for attention deficit/hyperactivity disorder (ADHD) really got his attention. 

Today, childhood sleep apnea is one of the most prominent topics in medicine and orthodontics. According to a 2012 position paper by the American Academy of Pediatrics, all children and adolescents should be screened for snoring and other clinical signs of sleep disorder. 

An observation of snoring in children is not normal, according to the paper. After examination, a sleep study to determine the severity of the sleep anomaly may be appropriate.

At least 82 percent of all patients who are symptomatic for sleep apnea go undiagnosed. A recent Johns Hopkins study concluded that children with obstructive sleep apnea (OSA) disorder appear to suffer damage in two brain structures tied to learning ability. Children with OSA had lower IQ scores (85) than non-OSA children (101). Similar deficits in OSA children were found on standardized test scores measuring verbal working memory and word fluency.

Other studies showed that this "learning debt" can be overcome with appropriate treatment for OSA if treated early enough.

Dr. Griffin holds a faculty position at Harvard University School of Dental Medicine where there is on-going child sleep apnea research being conducted. He said that childhood sleep apnea is caused by multiple factors and the diagnosis and treatment involves several medical and dental specialties all working together.

Dr. Jakum, a Warrenton pediatrician, said that "In addition to the neuro-cognative impairment, pediatric patients suffer from behavioral problems, difficulty in growth, hypertension, and heart dysfunction when obstructive sleep apnea is not addressed.

"Parents and clinicians have to remain keenly aware about the effects of poor sleep caused by sleep apnea and witnessed as simple snoring," he said. "Chronic headaches, daytime sleepiness, attention-deficit/hyperactivity disorder and learning problems are all behavioral symptoms of obstructive sleep apnea."

According to both Griffin and Jakum, a team approach involving the pediatrician, orthodontist, and Ear, Nose and Throat specialist, and a sleep specialist allow for the proper diagnosis and treatment.

"We've been working hard locally to develop this team approach with a coordinated effort to address the problem for each individual patient," Dr. Griffin said. "If children with OSA are diagnosed early enough, there are treatments involving orthodontics to improve the jaw relationship and size as well as working with the pediatricians and ENTs (ear, nose and throat specialists) to address the soft tissue (adenoids and tonsils) causes."

"We start screening for these problems at five to seven years of age in the orthodontic office. If these OSA symptomatic patients are not seen early, these corrective options may not be nearly as successful."

Griffin's passion for this work is obvious, perhaps even surpassing his other major pursuit as a lifelong horseman who now also is the co-chairman and director of racing for the International Gold Cup at Great Meadow in The Plains.

The pursuit of his profession also comes naturally. His father, a West Point graduate, finished dental school at Georgetown when he was 36 and practiced pediatric density for many years. Griffin went to the University of Virginia and dental school at the Medical College of Virginia. Prior to his faculty position at Harvard, he held the position of Associate Professor at Georgetown's dental school for eight years.

Griffin is paying close attention to Harvard's ongoing sleep apnea study. Their researchers are trying to determine which anatomical relationships predispose to adult sleep apnea.

"Despite some advertisements, there is no one solution to this complex problem," he said. "In order to have the best treatment outcome, all possible causative factors need to be evaluated. All treatments are aimed at increasing the size or volume of the posterior pharyngeal space, or 'breathing space,' but the appropriate treatment will be different for each patient."

One patient, he added, might benefit from orthodontic jaw expansion while another might find the most improvement with the management of the tonsils and/or the adenoids. That's why he believes that the team approach to OSA is so important.

"Hospitals and university settings have been using this team approach to diagnose and treat OSA with great success, and this treatment model is now in place locally," Griffin said. "This approach allows for a comprehensive diagnosis and less guesswork when you choose the right treatment for your child."