Treatment of OSAHS - Literature review Example

The role of socioeconomic and psychosocial factors on the adherence of mandibular advancement appliances. ObjectivesTo determine the effects of socioeconomic and psychosocial factors on the treatment of OSAHS. Background Obstructive Sleep Apnea Hypopnea Syndrome Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious medical condition that has been in the limelight for the past 5 decades. Over the years, it has become a major topic of discussion in both developing and developed countries within the medical field. Research has indicated that if proper treatment is not discovered, OSAHS could become a severe medical condition in the next one decade (Mitchelle et. al, 2013). Rapid increase of obesity, excessive weight and respiratory diseases in the world have been noted as a cause of concern by most scientists today. Most of them claim that these diseases are common causes of OSAHS. OSAHS can simply be described as a common cause of daytime sleepiness. Apnea in specific describes a 10 second pause in breathing while hypopnea refers to the reduction of ventilation by around 5%; eventually resulting to reduced saturation in the arteries. OSAHS generally causes the upper part of the air passage to collapse resulting in total or partial hypopnea or apnea. The dilating muscles of a patient with OSAHS are unable to oppose any negative pressure within the airway, which means that the airway neither contracts nor expands. In the long run, the airway becomes too narrow for constant air passage. When a patient is asleep, this effect occurs about 5 or 6 times. The symptoms of OSAHS that have been noted this far include loud snoring, choking during sleep, nocturia, non-refreshed sleep, headaches, sexual dysfunction and excessive daytime sleeping. It has been identified that the condition has various effects on patients. It is believed that OSAHS is a common cause of diabetes mellitus as it is highly resistant to insulin. The fact that obesity which is a common cause of diabetes mellitus also causes OSAHS makes scientists believe that the two conditions are highly related. OSAHS is also said to bring forth liver hepatic dysfunction due to the irregular sleeping patterns associated with it. The condition is said to have a very huge impact on the social life of a patient (Friedman, 2009). One experiences constant mood changes, reasoning instabilities and daytime sleepiness; all of which are directly related to how an individual associates with those around him. OSAHS is a very critical condition and it is very important that patients be informed of the diagnosis once it is made as well as the available treatment options. One very recommendable treatment option for any patient is a change in one’s lifestyle. This will include weight loss, change of sleep positions, cutting down of alcohol or smoking intake and withdrawal from any drugs that have effects on the respiratory system. Science has also availed the use of Modafinil as a curative drug as well as surgery depending on the level of OSAHS a patient is diagnosed with. The most recent treatment for OSAHS patients is the use mandibular advancement appliances (John, 1991). The mandibular advancement appliance is a form of oral appliance that is used for the treatment of OSAHS (Mitchelle et. Al, 2013). In the U.S market, there are over 55 oral appliances yet only 14 of these have met the standards set and have been approved by the Food and Drug Administration (FDA). The mandibular advancement appliances (MAA) have so far proved to be most effective among the 14 approved appliances. Patients who have used the different oral appliances also claim that the MAA is much simpler, comfortable and tolerable. The MAAs comes in two different forms; the pre-fabricated and individually designed one-piece appliance and the two-piece appliance. The MAA is inserted internally at night so as to externally displace the mandible and enlarge the air passage. This makes it easier for a patient to breathe without having episodes of the airway collapsing. Data Collection The data needed for this systemetic review was obtained from various medical journals and books that are listed at the end of the review and quoted in the findings. This method was found to be effective as it gave more information from various sources, hence more efficient in making a conclusion and arriving at our objective. Conclusion The OSAHS is without a doubt a condition that mostly affects the social aspect of an individual. Ranging from an individual’s social standing, education, income and social life been affected, OSAHS is definitely one condition that needs to be addressed permanently in the world today. Medics need to understand the socio-economic and psychosocial stand of the patient so as to know how to go about with the treatment procedures involved. Keywords: obstructive sleep apnea, socio-economic factors, psychosocial factors Socio-economic Factors Socio-economic factors are simply the social and economic aspects of life that contribute to an individual’s personality, lifestyle, morals, beliefs and attitudes towards life. Socio-economic factors will in the end define the status that an individual occupies in the society. One can either be branded as a high class, middle class or low class depending on their social and economic standing in the society (Johns, 1991). The socio-economic factors that are considered during such “branding” are income, education and occupation. Although other factors do exist, these three come in very handy especially in the modern society. Surprisingly, these factors also play a role on how a patient adheres or responds to the MAA treatment as discussed below. 1.Education Education generally refers to the knowledge and skill that one has acquired in school; either tertiary institutions or pre-tertiary level institutions. Leung suggests that education plays a major role in the skills that one develops, a person’s job as well as their level of income. In some societies, people with mere academic papers earn a lot of respect and are accorded very high status. Education confers the understanding that an individual needs to grasp what is going on around him as well as the changes that his body might present over time. Serious medical conditions such as OSAHS will require in depth understanding of scientific knowledge and terms (Leung, 2009). An uneducated person will not be in a position to understand why his body is behaving in a particular way as with the symptoms of OSAHS. In many cases, illiterate people will seek medical attention when the condition has already progressed to its latter stages (Adewole et. Al, 2009). Even then, they will need an in depth mind opening introduction to the condition as well as the treatment options available. When it comes to the MAA option, the most probable case is that they will not understand how or when to use the appliances. In other situations, one will fail to understand the relevance of using an appliance when they are asleep. Lack of education to an OSAHS patient is a very serious problem as most medics have come to realize. It becomes quite a task for them to give the finer details of the condition to a person who doesn’t understand the biological aspects of their own body. Medics are tasked with the responsibility to enlighten such patients with proper information of the OSAHS condition before they even administer treatment (Jameson, 2009). The MAA treatment that is issued to an illiterate patient will require constant follow up by the medics to see to it that he is using the appliances as and when required to do so. The patient is also enlightened on any possible side effects of the treatment so that he will be in a position to identify and report them should they arise. 2. Occupation Occupation refers to the economic activity that an individual is involved in so as to earn an income. A person’s occupation is said to directly reflect on their educational level as well as their income. There are some occupations that are held in high esteem in the society and they end up giving an individual an equally relevant high position in the society. They include occupations in the fields of accounting, architecture, medicine and law. These people are held in very high esteem, especially when it comes to decision making, public speaking or even leadership positions (Eckert, 2009). Given that people in highly esteemed occupations are considered educated, they are believed to understand their biological anatomy. Doctors automatically assume that these people are equipped with knowledge from various sources about OSAHS condition as well as the MAA treatment. This means that any person in such occupations suffering from this condition is able to understand the implications of the MAA treatment. This will include how the appliances are used, when to use them and how to recognize any side effects of the same. On the other hand, people who occupy occupations such as carpentry are considered less knowledgeable to the OSAHS condition as well as its treatment (McNicholas, 2001). 3. Income Income describes the level of earnings that an individual makes from his day to day work related activities. Income can be in the form of wages (weekly) or salaries (monthly). Any profit that an individual makes from a business is also termed as his source of income as is rent to a landlord. There are people who at the end of the day count their income in terms of billions, others in millions, thousands while others make hundreds. Irrespective of the level of income any OSAHS patient will require to access the needed medical care as and when he requires doing so. The Department of Health and Human Services argues that the Healthcare plan does not put into consideration any MAA expenses. Most health insurance policies in the U.S. have also not addressed this issue and no covers have been made for the same. This means that any individual suffering from this condition will have to cough up his own money for any expenses incurred (Olson et. Al, 2003). The MAA needs to be used on a daily basis or as recommended by a doctor. In any case, any patient opting for this kind of treatment must ensure that he has it at all times. This is most compelling as most doctors today recommend the MAA treatment due to proven efficacy in the years it has been in use. A patient earning a minimum wage of $100 weekly will have difficulties purchasing the mandibular advanced appliances. Doctors have also received reports on the side effects of continuous usage of the MAA treatment. The minor effects so far reported include dryness of lips, slight tenderness of the teeth and increased salivation at night. In severe cases, the MAA results to severe dental and skeletal damage (Sundaram, 2005). This serves as an extra expense to a patient who is already struggling to keep up with the costs already involved in the purchase and maintenance of the appliance. Psychosocial Factors The psychosocial factors of an individual refer to how his psychological and social well-being are interrelated. Psychosocial factors also explain how a person relates with the environment and the people around him. Psychology plays a very vital part in determining how a person responds to their environment as well as the situations that they find themselves in. Psychologists hold that any dysfunction that affects the psychological part of man will have adverse effects on his social, physical and mental wellbeing (Kalimo et. Al, 1987). Similarly, any damage to the physical state of an individual has a direct impact on his psychosocial well being. 1. Self-efficacy How a person views themselves is very important when it comes to OSAHS and the consequent treatment of the condition. The term self-efficacy in our case refers to a person’s view of themselves, regardless of what the society says. A person who believes in himself is likely to accept that he is suffering from a severe medical condition unlike a person who has low self-esteem. An individual with high self-esteem will not let the disease get them down in any way. They will have accepted the fact that they have a condition in them that needs to be treated (Olson, 2003). Such people believe that they would rather endure the treatment rather than lock themselves up in a house and spend forever wishing they were better. In such cases, the doctor will have an easy time explaining the situation to the patient as they have already accepted their situation. Usage of the MAA treatment is simplified as they understand the purpose of undergoing the treatment and they are willing to undergo it from the first day to when the doctor says “stop”. On the other hand, an individual with low self-esteem will have issues with wearing an oral appliance every time they fall asleep. Cases have been reported where some patients give up the use of the MAA treatment claiming that they are too embarrassed to continue using the appliances (Crummy et. Al, 2009). Such people need to be taught on the importance of accepting themselves and continuing the treatment for their own good. 2. Illness Perception Perception refers to what one thinks of himself or the situation surrounding him. The way that a person perceives something ultimately dictates how they react to it. It is very important for an OSAHS patient to be in a position to understand all the relevant information pertaining to his condition. Once one has grasped the relevant details, psychologists play their role by counseling and guiding them on how best to cope with their condition (Eckert et. Al, 2007). This will involve detailed techniques as the psychologist tries to tune the patient to accept their condition and learn to live with it positively. By so doing, one is able to accept himself and be psychologically prepared for their treatment. Jameson (2008) suggests that once a patient is able to understand that OSAHS is not a death sentence, they will be in a position to accept the treatment that the doctor recommends to them. In this case, the recommended treatment is the MAA. The patient is now in a position to understand the importance of constantly using the treatment in order to control his condition. Positive perception towards the illness and the MAA treatment will in the long run ensure that the patient is comfortable enough to use the appliances even when there are people around them. On the other hand, an individual who does not accept his situation and views the treatment probably as a waste of time and total embarrassment will not even adhere to the doctor’s treatment recommendations (Schellenberg, 2000). 3. Coping The MAA treatment, though highly effective is not that acceptable amidst patients. This could be attributed to the fact that the appliances are wired into a patient’s mouth and anyone within the vicinity of such a patient will identify the appliances.Coping is as a result of both self-efficacy and positive illness perception. Self-efficacy and positive illness perception means that a patient has accepted the condition that they have and they are willing to endure with the long term MAA treatment. This will eventually result to the patient practically living with his condition and treatment without any negative psychological effects (Gatchel, 1999). At this stage, the patient is said to have learnt how to cope with his situation fully. Coping means that a patient is fully comfortable with the MAA treatment and they will follow it to the letter. They adhere to the doctor’s instructions on how, where and when the appliances ought to be used. Any patient who has reached this level is said to have fully embraced the OSAHS condition and all the related side effects of the same. Such patients will opt to get treated instead of sitting at home. The MAA treatment on such an individual is taken with much obedience and resilience; with the hopes that someday things will be better (Kalimo, 1987). Discussion This review illustrates the various socio-economic and psychosocial factors that affect an individual’s response to the MAA treatment. An individual’s education level, occupation and the level of income play a vital role in how one reacts to the treatment while his self-efficacy, perception and coping mechanisms determine whether or not he will accept the treatment. The review has established a vvery strong connection between the mentioned factors and an individual’s response to the MAA treatment. 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