Stacey Quo, DDS, MS has made it her passion to help patients who might never know they have a sleep disorder, find rest.
Sometimes you discover sleep disorders in the most unlikely of places.
Like the orthodontist’s office.
Dr. Stacey Quo began her orthodontic career in 1994 in Palo Alto, California. She found herself interested in sleep medicine after a chance encounter with a patient who had undiagnosed severe obstructive sleep apnea (OSA). That encounter—just four years into her career as an orthodontist—was an adult male patient who was falling asleep during his short, ten-minute appointments.
When Dr. Quo inquired about his sleeping habits, the patient mentioned he was a college professor and would need to nap between his lectures. She referred him to a sleep study and was blown away by the results. “His case is so vivid in my memory because his oxygen saturation dropped to 54% and his Apnea Hypopnea Index (AHI) was 59.6.” AHI refers to the number of abnormal breathing events per hour of sleep. Mild levels are 5 to 14; 15 to 30 is moderate; greater than 30 is severe and this patient was experiencing nearly 60. Because of his dangerously low oxygen level, they stopped the study and placed a CPAP on him for the rest of the night.
MEETING A SLEEP PIONEER
As Dr. Quo moved forward with this patient’s treatment plan, she was fortunate enough to meet Dr. Christian Guilleminault, a French physician and a pioneer in the field of sleep medicine at the Stanford Sleep Clinic. Dr. Guilleminault, who passed away in 2019, is known for coining the term obstructive sleep apnea.
Under Dr. Guilleminault’s mentorship, Dr. Quo learned about sleep physiology. She also began recognizing sleep disorders in her own family. “I am so very grateful for his education, as it allowed me to better help care for my family to improve their longevity and
quality of life. As I treated more cases implementing what I learned, I saw profound changes in patients, and realized another impact the orthodontist has in the patient’s well-being, other than treating their oral health.”
Dr. Quo says that this is a common among professionals. While they are initially seeking help for their patients when they sit through one of her lectures, a secondary benefit is that their own family members are also helped. “Some of their questions relate to things they’ve noticed in their patients, but mostly it’s concerning symptoms or associations they’ve seen in their family.”
TREATING THE CHILD
Dr. Guilleminault was the first physician-scientist to describe pediatric sleep disordered breathing (SDB) back in 1976. “He felt that OSA was a disorder that began in childhood and approached OSA through the lens of early intervention in children to prevent the symptoms and manifestation seen in adults,” Dr. Quo relayed.
Recognizing that these children had certain oral and facial features, Dr. Guilleminault became aware that an orthodontist might be able to help. “He was acutely aware of the orthodontist’s ability to modify facial growth in treating bite problems,” Dr. Quo explained. An orthodontist can help with sleep disorders by expanding skeletal structures to improve airflow during the day and night. Recognizing how valuable the orthodontist is in helping treat SBD, Dr. Guilleminault became the world’s advocate for team collaboration between orthodontists, ENT surgeons, dentists, allergists, myofunctional therapists and oral surgeons.
It was actually at Dr. Guilleminault’s urging that Dr. Quo began treating young children in her office. Her first was a four-year-old patient. “I cautiously and perhaps reluctantly started upper jaw expansion and was surprised to see a dramatic improvement in daytime school engagement, irritability, anxiety and temperament. Then I started widening the lower teeth and found more improvement. Now this is a therapy we routinely utilize. And this brought us to implementing other strategies to enlarge the upper airway by improving the mode of breathing, developing the upper jaw forward and improving the performance of the upper airway musculature.
We’re using these therapies in adults too.” Dr. Quo is careful to note that multiple therapies may be needed and there still may be residual OSA after treatments.
THE SLEEP DISORDER CONNECTION TO THE DENTAL CHAIR
Dr. Quo explains how dental work can walk hand-in-hand with SBD and OSA. “Structurally, the upper airway comprises the nose and the throat (pharynx). There is a shared anatomy as the nose sits inside of the upper jaw and the upper and lower jaws form one of the walls of the throat (pharyngeal airway). The pharynx or throat is a susceptible site for airway collapse during sleep. The upper airway is a complex of three distinct but contiguous structures: the nose, the mouth and the throat, separated anatomically by the upper jaw/maxilla.” She goes on to explain, “When the nose is congested and nasal breathing is blocked, the mouth acts as a respiratory organ. This bimodal switching between nose to mouth breathing and the amount of time spent in each mode affects the development of the lower part of the face: the jaws, the teeth and the airway. It’s an integrated space, where chewing, swallowing, breathing and speaking are executed. The musculature governs these functions as directed by voluntary and involuntary signals from the brain.”
Characterizing the face is a routine part of an orthodontist’s job during an exam on a patient. The dentist and orthodontist therefore play a vital role in helping patients who might not think they have a problem and would never consider going to a sleep clinic. “SDB/OSA prevalence studies suggest a large percentage of mild to moderate adult sleep apnea is undiagnosed as patients may not be aware of the spectrum of associated symptoms.”
Because sleep disorders are so detrimental to a person’s health, these yearly appointments with their dentist or orthodontist can be incredibly helpful to identify facial and oral risk factors. They are becoming “standards of care” in dentistry.
“It’s always surprising and humbling when parents mention that treating the SDB/OSA has given them their child back, or when adult patients report that treatment has been life changing or that they can now breathe, and that they didn’t
know they couldn’t breathe–until they could!”
There are other options besides CPAP and pharmacotherapy, and it is Dr. Quo’s hope that she can continue to help people who didn’t even know there was a problem, finally benefit from much-deserved rest.
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Wendi Kitsteiner is a former high school English and Journalism teacher who has worked as a writer/editor for the RLS Foundation and as an editorial assistant for a cardiovascular researcher at Mayo Clinic. She has written for many magazines and websites and is currently homeschooling her four children on a farm in East Tennessee.
