Everyone Deserves a Good Night's Rest.

How Does Sleep Apnea Occur?

Obstructive sleep apnea (OSA) occurs when the upper airway narrows or collapses during sleep, blocking some or all airflow. Risk is higher for people with a large tongue or tonsils, who are male, older, or who carry excess weight. OSA is by far the most common type of sleep-disordered breathing, making up about 80% of cases in the U.S., according to the American Dental Association.

How We Screen for Sleep Apnea Risk

Untreated obstructive sleep apnea isn't just about feeling tired — according to a 2021 scientific statement from the American Heart Association, OSA is present in an estimated 40–80% of people with hypertension, heart failure, coronary artery disease, atrial fibrillation, or stroke, and it remains widely underdiagnosed in cardiovascular care. That's part of why a thorough airway risk screening is a standard part of your exam here, alongside the quiz above.

The Mallampati Classification

One tool we use is the Mallampati Classification — a simple, non-invasive exam where you open your mouth and relax your tongue (no sound needed) so we can see how much of your soft palate, uvula, and pillars are visible. It was originally developed to help anesthesiologists anticipate a difficult airway before surgery, but it's since become a widely used indicator of airway crowding in sleep medicine too: research has found that each one-point increase in Mallampati class roughly doubles the odds of having obstructive sleep apnea, and a Class III or IV finding is considered a meaningful risk factor.

A higher class (more of the tongue base blocking the view) generally means less room in the airway.

An honest caveat: Mallampati class is one data point, not a diagnosis on its own — some patients with a low Mallampati score (Class I or II) still have meaningful airway obstruction, so we weigh it together with tonsil size, neck circumference, jaw position, and your reported symptoms, the same factors behind the quiz above. A home or in-lab sleep study is still what actually confirms an OSA diagnosis and its severity.

Understanding Your AHI (Apnea-Hypopnea Index)

If a sleep study confirms OSA, your results include an AHI score — the average number of breathing pauses (apneas) and partial blockages (hypopneas) per hour of sleep. That number defines severity:

Mild-to-moderate OSA is often a good fit for oral appliance therapy; more severe cases may need CPAP, or a combination approach — Dr. Boris Zusin reviews your specific sleep study results with you to recommend what's appropriate.

If You Also Grind Your Teeth: What's the Real Connection?

Teeth grinding (bruxism) and obstructive sleep apnea overlap often — roughly 20–50% of adults with either condition show signs of the other. But that overlap doesn't mean one clearly causes the other: most current evidence doesn't establish a consistent causal link between the two in adults (the connection looks stronger and more plausible in children). The leading theory ties both to brief arousals during sleep — grinding tends to happen right at the tail end of one of these micro-wake-ups, and a breathing pause is one of the things that triggers them. So grinding may largely be a byproduct of the same sleep disruption driving the apnea, rather than something the apnea directly causes.

Why this matters for treatment: a standard upper night guard, on its own, can in some patients reduce space in the airway — the wrong direction if sleep apnea is also present. That's part of why we assess airway risk (see the screening above) in patients who report grinding, rather than treating a night guard as a one-size-fits-all fix. When sleep apnea is confirmed alongside grinding, airway-focused therapy — CPAP or an oral appliance like Panthera that advances the lower jaw — is generally the better starting point, and treating the apnea often reduces the grinding as a side benefit, though the two don't always improve in exact proportion to each other.