By: Dr. Robert Rawdin, D.D.S., F.A.C.P.
As a prosthodontist, I am keenly aware of sleep disordered breathing problems. Obstructive sleep apnea is the most common disorder. It is estimated that 1 in 5 adults has some degree of sleep apnea.
Sleep apnea is an airway problem, and treating complex dental issues affects jaw posture and potentially affects how well you breathe at night. I have treated many patients with sleep apnea with oral appliances, and the potential health benefits can be very dramatic. Having a patient able to stop taking high blood pressure medication or seeing improvements in blood sugar levels (preventing type 2 diabetes) is very gratifying as a healthcare professional.
My latest blog discusses some new findings and really expresses the importance of treating sleep disordered breathing.
What Is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is widely recognized for its hallmark symptoms—loud snoring, fragmented sleep, and daytime fatigue. However, research over the last decade has begun uncovering deeper neurological consequences linked to this condition.
The Hidden Risk: Cerebral Microbleeds
One of the most concerning findings is the association between OSA and cerebral microbleeds—tiny areas of bleeding within the brain that may be early indicators of vascular injury. Though small in size, these microbleeds can have meaningful implications for long-term brain health.
OSA occurs when the airway repeatedly collapses during sleep, causing intermittent pauses in breathing. Each pause leads to a drop in oxygen levels, followed by a surge of stress hormones each time the brain intervenes to reopen the airway.
This cycle can repeat dozens or even hundreds of times per night. Over time, these fluctuations put immense strain on the cardiovascular system, contributing to elevated blood pressure, inflammation, and endothelial dysfunction—the impaired function of blood vessel linings.
What Are Cerebral Microbleeds?
Cerebral microbleeds are pinpoint spots of blood leakage from small vessels within the brain. They are most commonly detected through specialized MRI sequences. Although microbleeds do not always produce noticeable symptoms, their presence signals chronic vascular damage and is associated with higher risks of cognitive decline, stroke, and dementia. Traditionally, microbleeds have been linked to hypertension and amyloid angiopathy, but OSA is increasingly recognized as an independent contributor.
How OSA Contributes to Brain Vessel Injury
The mechanism connecting OSA to microbleeds likely involves chronic intermittent hypoxia—the recurring periods of low oxygen levels during apneic episodes. This hypoxia triggers oxidative stress and inflammation, which can weaken the walls of delicate brain vessels. Additionally, the frequent nighttime blood pressure spikes associated with OSA create mechanical stress on these vessels, further increasing vulnerability to rupture. Together, these effects create an environment conducive to small-vessel injury and microbleed formation.
What the Research Shows
Several clinical studies have reported that individuals with moderate to severe OSA show a higher prevalence of cerebral microbleeds compared to those without the disorder. Notably, deep brain microbleeds—often associated with hypertension—appear particularly linked to OSA. These findings suggest that OSA may accelerate vascular aging, contributing to long-term neurological consequences.
Impact on Cognitive Health
The presence of microbleeds may also help explain why some patients with OSA experience difficulties with memory, attention, or executive functioning. While not all individuals with OSA develop cognitive symptoms, persistent small-vessel damage could play a role in the progression toward dementia, especially when combined with other risk factors like hypertension or diabetes.
Treatment Options That Protect the Brain
Fortunately, treatment for OSA may help mitigate these risks. Continuous positive airway pressure (CPAP), the most common therapy, helps keep the airway open, preventing intermittent hypoxia and reducing nighttime blood pressure surges. By stabilizing oxygen levels and easing vascular strain, CPAP may slow or prevent the development of microbleeds, although more research is needed to confirm long-term benefits.
Patients that do not tolerate a CPAP can use a dental appliance that positions the lower jaw forward during sleep. This appliance helps to keep the airway open during sleep. Oral appliance efficacy is similar to CPAP in many studies.
Proactive Prevention Matters
Lifestyle adjustments—such as weight loss, exercise, avoiding alcohol before bedtime, and managing blood pressure—can further reduce vascular risk. Early screening and diagnosis are essential, particularly for individuals who snore heavily, feel excessively sleepy during the day, or have cardiovascular disease.
Conclusion
While the relationship between OSA and cerebral microbleeds remains an evolving field of study, the evidence underscores the importance of recognizing sleep apnea as more than a sleep issue—it is a systemic disorder with significant implications for brain health. Addressing OSA proactively may not only improve sleep quality but also help protect the brain from silent, accumulating damage.
If you have questions about sleep apnea or treatment options, please visit the sleep disorder page on our website or give us a call — our team is here to help you protect your health and sleep better. Call us at (212)246-8700 to set up a consultation today! Follow Gallery57Dental on Facebook here!
