Another Mouth/Body Link: Obstructive Sleep Apnea & Endocrine Disorders

Obstructive sleep apnea (OSA) isn’t just an annoyance to your sleep partner or something that only leaves you waking up tired every day. Consider what it involves: You stop breathing for 10 seconds or more, again and again and again, all through the night. Each time, the sudden lack of oxygen sends your body’s survival mechanisms into red alert – again and again and again.

As you watch the video below, try holding your breath through the parts where the caption shows that breathing stops. Think about how your body feels.

OSA is quite literally life-threatening. Left untreated, it means a higher risk of early death, not to mention things like heart disease and stroke.

But while you have heard something about the relationship between OSA and cardiovascular conditions, you might not know that sleep apnea has also been linked to numerous endocrine disorders. Simply, these are conditions in which one or more parts of your body’s hormone-producing system stops working properly. Those that have been linked to OSA include obesity, diabetes, hypothyroidism, and acromegaly (a condition in which the pituitary gland produces too much growth hormone in adulthood).

A recent paper on this OSA-endocrine relationship suggests that the relationship is a two-way street. An endocrine disorder can affect the trajectory of sleep apnea, and vice versa. And treating one condition may improve symptoms in the other.

However, all of the evidence given in this paper focuses mainly on CPAP, which uses air pressure to keep the airway open and clear. It’s effective. It’s saved lives. But many people don’t like it.

Some find the mask or nasal pillows uncomfortable and tear them away during sleep. Or they don’t like the hassle of toting along medical equipment any time they have to travel. Or they just don’t like the idea of being tethered to a machine and reliant on electricity just to sleep.

For a long time, CPAP was the only option, but oral appliance therapy has emerged as an excellent alternative, especially in cases of mild to moderate OSA and in severe cases when a person is CPAP-intolerant.

And that brings us to a paper from this past summer, which reviewed the multisystemic effects of oral appliance therapy. Combing through more than four decades of scientific literature, its authors identified 41 studies that met their criteria for analysis.

Overall, they found good evidence that oral appliance therapy can improve high blood pressure, metabolism, cognitive function, depressive symptoms, headache, quality of life, and telomere length (a marker of biological age and longevity).

For endocrine issues in particular? Here, the evidence is a bit mixed. Some studies have shown that oral appliance therapy improved glucose control for patients with type 2 diabetes and either mild or moderate OSA. Other studies have found no significant effect whether an appliance or CPAP was used.

But this also points to one of the real limitations of this review: Relatively little research has been done in this area, and the studies that have been done tend to be small. While some of the findings are promising, more data is needed to determine just how effective oral appliance therapy can be in this regard.

It also highlights the need to take a truly holistic approach to one’s health, especially in looking at the relationship between mouth and body. The ideal is to identify and treat root causes rather than perpetually trying to tame symptoms – and that includes exploring where conditions can intersect. Most modern illness, after all, is multicausal.

Always, you’ve got to look at the big picture.

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