The College of Dental Surgeons of Hong Kong

SPRING SCIENTIFIC MEETING 2022

What is Sleep Disordered Breathing and How Are We Related?

Moderators of AM session: Dr. Jeni HO and Dr. Yung KI
08:40 – 08:45 Welcome Remarks
Dr. Katherine Chiu Man LEUNG
President, The College of Dental Surgeons of Hong Kong
08:45 – 09:30 Multidisciplinary Management of Obstructive Sleep Disordered Breathing
Dr. Siu Chung FUNG/ Dr. Angus HO/ Dr. Michael CHAO/ Dr. Crystal NG
OMFS and Orthodontics, HA
09:30 – 10:15 An Interdisciplinary Approach to Childhood Sleep Disordered Breathing
Dr. Daniel NG - Pediatrician, HKSH
10:15 – 10:45 Sleep Disordered Breathing - From Pathophysiology to Management
Dr. Kah-lin CHOO, Medicine, NDH
10:45 – 11:00 Q&A
11:00 – 11:15 Break
Investigation and Interpretation
11:15 – 11:45 Sleep Study from Dental Perspective
Mr. Alex SUM - Sleep Technician, UCH
11:45 – 12:15 Role of ENT Surgeons in SDB Evaluation
Dr. Natalie LEUNG - ENT, PWH
12:15 – 12:30 Q&A
12:30 – 13:45 Lunch break (no lunch will be provided)
Treatment of Sleep Disordered Breathing and Dental Role
Moderators of PM session: Dr. Chun Sing KUM and Dr. Kim SAM
13:45 – 14:15 Sleep Disordered Breathing – Orthodontic Aspect
Dr. Vicky TSUI - Orthodontics, HKU
14:15 – 14:45 Sleep Disordered Breathing – Oral Appliance
Dr. Min GU - Orthodontics, HKU
14:45 – 15:15 Surgical Treatment of Snoring and Obstructive Sleep Apnea from ENT Perspective
Dr. Zion TO - ENT, UCH
15:15 – 15:30 Break
15:30 – 16:00 Sleep Disordered Breathing – The Role of Oral and Maxillofacial Surgeons
Dr. Ivan YING/ Dr. Teresa LO - OMFS, HA
16:00 – 16:30 Myofunctional Therapy for Patients with Sleep Disordered Breathing
Dr. Stephen CHAN - Physiotherapist, HKCH
16:30 – 16:45 Q&A
16:45 – 17:30 Panel Discussion on Treatment
Dr. Stephen CHAN, Dr. Siu Chung FUNG, Dr. Min GU, Dr. Jeni HO, Dr. Vicky TSUI, Dr. Zion TO
Disclaimers: The views and opinions expressed at the 2022 Spring Scientific Meeting are those of the speakers and do not necessarily reflect the official
policy or position of the College of Dental Surgeons of Hong Kong. Any content provided by our speakers is of their opinion, and is not intended to
malign any religion, ethic group, club, organization, company, individual or anyone or anything.

CDSHK CME/CPD: (AM) 3.5 points <Cat A> ; (PM) 3.5 points <Cat A>
DCHK CPD: (AM) 3.5 points ; (PM) 3.5 points [Max. 5 points for the whole day]
Format: Virtual / Physical (Pao Yue Kong Auditorium, HKAM Jockey Club Building, Aberdeen)

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 Dr. FUNG Siu-chung
Specialist in Oral and Maxillofacial Surgery
BDS, MDS, FRACDS, FCDSHK (OMS), FHKAM (Dental Surgery)

Dr. FUNG Siu-chung is the Chief of Service of the Department of Dentistry & Maxillofacial Surgery in the
United Christian Hospital, and the Dentistry & Maxillofacial Surgery Service Network in the Hospital Authority.
He is also a part-time clinical lecturer in the Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry of
the University of Hong Kong.

He obtained both of his dental and maxillofacial surgical training locally in the University of Hong Kong. He
was admitted as a fellow of the Royal Australasian College of Dental Surgeon since 1990, Fellow of the Hong
Kong Academy of Medicine (Dental Surgery) in 1993 and the College of Dental Surgeons of Hong Kong (OMFS)
in 2000.

His main clinical interests are orthognathic surgery, jaw distraction osteogenesis and secondary cleft surgery.

Dr. HO Cheuk Hin Angus

Higher Trainee in Orthodontics
BDS (HK)(Hons), MDS (Orthodontics & Dentofacial Orthopaedics)(HK)

Dr. Angus HO graduated from the Bachelor of Dental Surgery and the Master of Dental Surgery in
Orthodontics and Dentofacial Orthopaedics in HKU in 2012 and 2020 respectively. He worked in the
craniofacial orthodontic team in the Dentistry and Maxillofacial Surgery Network in the Hospital Authority
for four years before entering the training pathway in the specialty of orthodontics. He is currently a higher
trainee in the specialty of orthodontics and a part-time dental officer in the United Christian Hospital and
Hong Kong Children’s Hospital. His special interests are the orthodontic management of patients with cleft
lip and palate as well as sleep disordered breathing. He had a few publications in these areas in the Journal
of Orthodontics and Cleft Palate and Craniofacial Journal.
 Dr. CHAO Tsz Kwan Michael
Basic Trainee in Oral and Maxillofacial Surgery
BDS (HKU)

Dr. Michael CHAO graduated from the Bachelor of Dental Surgery, HKU in 2020. He is currently a basic
trainee in the Oral & Maxillofacial Surgery at United Christian Hospital, Hospital Authority.

Dr. NG Wing Yau Crystal

Basic Trainee in Oral and Maxillofacial Surgery
BDS (HKU)

Dr. Crystal NG is a dental officer currently training at the Department of Dentistry and Maxillofacial
Surgery in United Christian Hospital. She graduated from the BDS program of the University of Hong Kong in
2019 and started her training in OMFS since 2020.

“Multidisciplinary Management of Obstructive Sleep Disordered Breathing”

Speakers: Dr. Siu Chung FUNG/ Dr. Angus HO/ Dr. Michael CHAO/ Dr. Crystal NG
Sleep Disordered Breathing (SDB) is an umbrella term encompassing various breathing disorders during sleep.
SDB is underrecognised yet causes significant morbidity and mortality. Causes are multifactorial and hence
treatment requires a multidisciplinary approach. In this presentation, we will highlight the major causes and
dental management of SDB.
 Dr. NG Kwok Keung Daniel
Specialist in Paediatric Respiratory Medicine
MBBS (HK), MRCP (UK), FRCP (Edin), Grad Dip (Derm), NUS, FRCPCH, M Med Sc (HK),
MD (HK), FHKCPaed, Dip Epidemiology and Applied Statistics (CUHK),
FHKAM (Paediatrics)

Dr. Daniel K. NG is the Founding President of Asian Paediatric Pulmonology Society. He is currently the
Honorary Consultant Paediatrician in the Hong Kong Sanatorium & Hospital, Kwong Wah Hospital and United
Christian Hospital in Hong Kong. He is the Distinguished Visiting Professor, National Center for Children’s
Health, China and Beijing Children’s Hospital, Capital Medical University, China. He is the honorary council
member of the Hong Kong Society of Paediatric Respirology & Allergy. He serves in the Board of Directors of
Clean Air Network, a NGO for promotion of cleaner air in Hong Kong.

He was accredited as subspecialist in paediatric respiratory medicine by the Hong Kong College of
Paediatricians in 2016 and awarded diplomate in paediatric respiratory medicine by ERS in 2016. He was
certified as specialist in sleep disorders by the World Association of Sleep Medicine in 2014.

On the international level, he is currently the head-elect of the paediatric assembly of APSR. He served as
council member of the World Association of Sleep Medicine and international affairs committee member of
the American Thoracic Society and the American Academy of Sleep Medicine as well as the regional director
of the International Pediatric Sleep Association.

Dr. Ng’s main research interests are sleep-disordered breathing, asthma and allergic rhinitis. Dr. Ng has
published 100+ peer-reviewed papers in journals indexed in Web of Science with > 1,000 citation. His H-index
is 20. He is currently the associate editor of Journal of Pediatric Respirology and Critical Care Medicine and
Respirology Case Reports.

“An Interdisciplinary Approach to Childhood Sleep Disordered Breathing”

Childhood sleep disordered breathing (SDB) is a very common disorder in Hong Kong children. The
commonest symptom of childhood SDB is habitual snoring which occurs in 10% of Hong Kong children.
Common signs of childhood SDB include nasal blockage due to allergic rhinitis and malocclusion.

Pathogenesis of childhood SDB include maxilo-mandibular hypoplasia, obesity, muscle weakness, mouth
breathing and mucosa inflammation/hypertrophy. A proper management begins with an accurate diagnosis
which would mean a sleep polysomnography. Sleep endoscopy is needed to identify the sites of obstruction.

To deal with ALL the sites of obstruction, an inter-disciplinary team with paediatric respirologist,
orthrodontist, maxillofacial surgeon, ENT surgeon is needed.
 Dr. CHOO Kah Lin
Specialist in Respiratory and Critical Care Medicine
BMBS(Nottm), MRCP(UK), FRCP(Edin, Glasg), FHKCP, FHKAM

Dr. Kah Lin CHOO is currently the Chief of Service of Medical Department at North District Hospital. She
is also an honorary Clinical Associate Professor at Chinese University of Hong Kong. She is an Executive
Committee member of CHEST (Hong Kong and Macau Delegation), an Executive Board Member of Hong Kong
Lung Foundation and the past President of Hong Kong Society of Sleep Medicine. Dr Choo graduated from
University of Nottingham, United Kingdom, in 1990. She underwent Respiratory Medicine, Advanced Internal
Medicine and Critical Care Medicine training at Pamela Youde Nethersole Eastern Hospital and North District
Hospital respectively. After receiving training in Sleep Medicine at Stanford University Sleep Disorders Center
under Professor Guilleminault in 1996, she set up sleep services at Pamela Youde Nethersole Eastern Hospital
in 1997 and North District Hospital in 2001. Her interests in sleep medicine range from obesity
hypoventilation syndrome to complex sleep disordered breathing. She is a Fellow of Hong Kong College of
Physicians, Hong Kong Academy of Medicine, Royal College of Physicians of London, Royal College of
Physicians of Edinburgh and Royal College of Physicians of Glasgow. She has served as a reviewer for Hong
Kong Medical Journal and Respirology.

“Sleep Disordered Breathing - From Pathophysiology to Management”

The human pharynx can be considered a collapsible tube, the susceptibility of which is related to our unique
long airway that facilitates speech and a floating hyoid bone that facilitates swallowing. Soft tissue crowding
and our rigid craniofacial skeletal framework can reduce pharyngeal space and narrow the upper airway.

During sleep, there is increase in upper airway and intrathoracic airway resistance. This increase in
inspiratory and expiratory resistance rises further in obese subjects. To counteract the raised negative
intrathoracic pressure, we rely on compensatory neuromuscular responses and the effectiveness of
pharyngeal dilator muscles to keep the airway open.

Snoring and obstructive apnoea result from narrowing or complete occlusion of the upper airway during
sleep. Snoring sound is usually generated by the oscillation of pharyngeal muscles. It is no wonder during
rapid eye movement (REM) sleep when skeletal muscles are paralysed, snoring is absent. At the same time,
apnoeic events and the ensuing hypoxaemia are at their worst during REM sleep.

Repetitive obstructive events lead to catecholamine surges and sleep instability. Obstructive sleep apnoea
patients rely on arousals to restore upper airway patency. However, premature arousals from sleep can lead
to excessive ventilatory responses. Respiratory control instability can be perpetuated when carbon dioxide
level oscillates between the apnoea threshold of wakefulness and that of sleep.

Treatment of sleep-disordered breathing (SDB) depends on the severity of SDB, impact on the patients’
daytime functioning and sleep quality as well as the presence of complications. A personalized treatment
should also be tailored to the underlying pathophysiology, whether it is purely an anatomical cause (imposed
by skeletal or soft tissue constraints) or in combination with factors such as poor muscle responsiveness, low
arousal threshold or an over-sensitive ventilatory response.
 Mr. SUM Yun Sang Alex
Sleep Technician, United Christian Hospital
BEng (Medical Engineering), RPSGT

Mr. Alex SUM is a sleep technologist in United Christian Hospital. Mr. Sum joins a sleep diagnostic service
company as service engineer since his graduation from The University of Hong Kong. He had worked on Sleep
laboratory setup and CPAP therapy at this period. Mr. Sum had also certified as registered sleep technologist
(RPSGT) In 2015 during he stayed at private sector. Mr. Sum joins the United Christian Hospital as a sleep
technologist since the beginning of the Integrated Sleep Diagnostic and Therapeutic Unit in 2018. He is now
working on sleep diagnostic, PAP titration and orofacial myofunctional therapy services. Mr. Sum also
obtained BRPT pediatric sleep certificate in 2021.

“Sleep Study from Dental Perspective”

Sleep study is the tool to investigate sleep disorder of the patient. From dental perspective, many dental
patients may with symptoms or risk factors in sleep breathing related disorder (SBRD) such as daytime
sleepiness, snoring, large tongue, tongue tie, retrognathia or enlarged tonsils. Sleep study may require for
these patients to examinate their sleep disorder.

Sleep study can be divided into two categories in simple: In-lab Polysomnography (PSG) and home sleep
apnea test (HSAT). PSG is the gold standard for the diagnostic of sleep disorder and HSAT is a convivence and
effective tool for evaluate sleep breathing disorder (SBRD) without medical complication. Both HSAT and PSG
are well established in Hong Kong and available in both public and private sector. Results of the sleep study
can be provided by computer-based evaluation, but it will have much better reliability for having human
manual interpretation.

Result of a sleep study may be complicated and consist of much information. In view of sleep breathing
disorder perspective, Respiratory Disturbance index (RDI) in PSG or Respiratory Events Index (REI) in home
sleep study is the primary index should be considered. RDI/REI describe the severity of sleep apnea of the
patient which is the key index to determine the needs of further treatment and treatment option. Other
information such as positional RDI difference, desaturation index or respiratory events duration may also
help evaluate patient conditions and predict the succession for different treatment options.
 Dr. LEUNG Moon Wah Natalie
Specialist in Otorhinolaryngology
MBChB(CUHK), MRCSEd, FRCSEd(ORL), FHKCORL, FHKAM(ORL)

Dr. Natalie LEUNG graduated from the Chinese University of Hong Kong and completed her training in
Otorhinolaryngology at Prince of Wales Hospital.

She has special interest in Sleep surgery and Sleep medicine. After obtaining her fellowship in 2012, she
underwent overseas training in the Sleep surgery division of Stanford University and Medical College
Wisconsin. Currently she is Consultant of the Department of the Ear, Nose and Throat of the Prince of Wales
Hospital, and clinical associate professor (honorary) of the Department of Otorhinolaryngology, Head and
Neck Surgery of the Chinese University of Hong Kong.

Dr. Leung was the key person to establish an integrated sleep service in the Prince of Wales Hospital since
2017, with collaboration between the Departments of Medicine, Psychiatry, Paediatrics. She was the
organizer or faculty of several local sleep surgery courses or conferences. There was collaboration between
the Department of Otorhinolaryngology of Chinese University of Hong Kong and Stanford University since
2018, aimed to provide different spectrum of sleep surgeries in Hong Kong.

“Role of ENT Surgeons in SDB Evaluation”

Surgery is the first line treatment for paediatric OSA patients, while Positive airway pressure is gold standard
for adult OSA. However, the compliance is only 40% in general. Appropriate selection for surgical candidate
is tremendously important for treatment success. The role of ENT surgeons in the evaluation of sleep
disordered breathing is mainly the upper airway assessment. With systematic clinical and endoscopic
examinations, we could identify the level of upper airway obstruction, which could be located in the nasal
cavity, oral cavity, oropharynx or even the larynx. DISE is another very important procedure performed by
ENT surgeons, it allows a dynamic evaluation of the upper airway during sleep. Sometimes we work together
with Oral-maxillofacial surgeons to formulate a surgical plan to our OSA patients.
 Dr. TSUI Wing Kei Vicky
Specialist in Orthodontics
BDS (HKU), MOrth (HK), M Orth RCSEd, MRACDS (Orth), AdvDipOrth (HK),
FHKAM (Dental Surgery), FCDSHK (Orthodontics)

Dr. Vicky TSUI is a Specialist in Orthodontics in Hong Kong. She obtained her Bachelor of Dental Surgery
(BDS) and Master of Orthodontics (MOrth) from the University of Hong Kong. She also holds the membership
of Orthodontics from The Royal College of Surgeons of Edinburgh.

Dr. Tsui works in private practice and was appointed as Honorary Clinical Assistant Professor in the discipline
of Orthodontics, Faculty of Dentistry, the University of Hong Kong.

She has developed her special interests in paediatric sleep dental medicine and myofunctional therapy. She
completed training as a Myofunctional therapist two years ago. Recently, she has completed a Mastery
Program in Dental Sleep Medicine collaborated by American Academy of Dental Sleep Medicine (AADSM)
and Tufts University Boston. She obtained the International Certificate of American Board of Dental Sleep
Medicine (ABDSM) in 2020.

“Sleep Disordered Breathing – Orthodontic Aspect”

This lecture will focus on the role that orthodontics can play in the management of obstructive sleep apnea.
Special focus on a range of treatment modalities which target patients in different age groups and
phenotypes. The lecture will provide an evidence-based approach and support with clinical cases.
 Dr. GU Min
Clinical Assistant Professor in Orthodontics, Faculty of Dentistry, HKU
BDS (Wuhan), MDS(Orth) (Sichuan), AdvDipOrth (HK), MOrth RCSEd, PhD (HK),
FDS RCSEd

Dr. GU Min received orthodontic specialty training in West China school of Stomatology, Sichuan
University and the University of Hong Kong successively, and obtained MOrth and AdvDipOrth degrees in
2003 and 2006, respectively. He obtained the MOrth RCS (Edin) from the Royal College of Surgeons of
Edinburgh in 2008, the Fellowship (FDS RCS Ed) in 2016, and Ph.D. from the University of Hong Kong in 2016.
Since April 2014, he has been a Clinical Assistant Professor in Orthodontics at the Faculty of Dentistry, the
University of Hong Kong. Dr. Gu’s research interests are sleep disordered breathing and orthodontic
functional appliance therapy, and 3D technology-assisted orthodontic diagnosis and treatment.

“Sleep Disordered Breathing – Oral Appliance”

Oral appliances (OAs) have become an increasingly common treatment modality for OSA. This presentation
will briefly describe the latest recommendations for the treatment of adult OSA patients with OAs. The
presentation will also highlight the care of pediatric OSA patients with OAs in terms of the indications,
appliance selection and treatment effect supported by contemporary evidence and clinical cases.
 Dr. TO Wing Hei Zion
Specialist in Otorhinolaryngology
MBChB (CUHK), FRCSEd (ORL), FHKCORL, FHKAM (Otorhinolaryngology)

Dr. Zion TO graduated from The Chinese University of Hong Kong. He pursued his specialty training in
Otorhinolaryngology and Head & Neck Surgery at the United Christian Hospital, Prince of Wales Hospital and
Alice Ho Miu Ling Nethersole Hospital. He was awarded the Gold Medal Award in the Joint Intercollegiate
Specialist Examination in Otorhinolaryngology in 2018 and was granted the Distinguished Young Fellow
Award by the Hong Kong Academy of Medicine in 2019. He is currently a resident specialist at United
Christian Hospital and Honorary Clinical Assistant Professor of the Chinese University of Hong Kong with
special interests in sleep surgery, rhinology and skull base surgery.

“Surgical Treatment of Snoring and Obstructive Sleep Apnea from ENT Perspective”
Obstructive sleep apnea (OSA) is the most common sleep disordered breathing affecting 5% middle aged
men 3% middle aged women. It is the end result of multilevel obstruction and is characterized by repeated
episodes of partial or complete obstruction of the upper airway during sleep. Many patients exhibit poor
compliance and tolerance to nightly use of effective nonsurgical treatment of continuous positive airway
pressure (CPAP). Various surgical procedures have been proposed to promote CPAP usage and, in some cases,
treat OSA. Effective surgical management depends upon the severity of disease and the identified level of
obstruction in sleep nasoendoscopy assessment. Surgical options can be divided into single versus multilevel
surgery. Moreover, it can be further classified into soft tissue and bony framework surgery. Different surgical
options to treat snoring and OSA would be discussed in this scientific meeting.
 Dr. YING Chin Ho Ivan
Specialist in Oral and Maxillofacial Surgery
BDS, FCDSHK, FHKAM

Dr. Ivan YING graduated from Faculty of Dentistry, the University of Hong Kong in 2007. He completed
his training in Oral and Maxillofacial Surgery in Department of Health and was admitted as fellows of the
College of Dental Surgeons of Hong Kong (CDSHK) and the Hong Kong Academy of Medicine (HKAM) in 2018.
He was awarded Distinguished Young Fellow by HKAM in the same year.

Dr Ying joined the Oral and Maxillofacial Team of the Hospital Authority Dental Service Network in 2019. He
was appointed by CDSHK as a Trainer in Oral and Maxillofacial Surgery of the training centre since 2020. He
actively participated in the inter-disciplinary management of the obstructive sleep apnoea patients. Apart
from clinical service, he is also enthusiastic in sharing his expertise and experience in various training
activities.

Dr. LO Hau Yu Teresa

Basic Trainee in Oral and Maxillofacial Surgery
BDS (HKU) (Hons), MFDS RCSEd, MFDS RCPS (Glasgow)

Dr. Teresa LO is currently a trainee in Oral & Maxillofacial Surgery, United Christian Hospital, Hospital
Authority. She graduated from the University of Hong Kong with Honours and academic prizes in 2017. She
previously served the Department of Oral & Maxillofacial Surgery, Prince Philip Dental Hospital, as Junior
Hospital Dental Officer from 2017-2018. She obtained her Diploma of Membership of the Faculty of Dental
Surgery (MFDS) of the Royal College of Surgeons of Edinburgh and the Royal College of Physicians and
Surgeons of Glasgow (RCPSG) in 2019.
“Sleep Disordered Breathing – The Role of Oral and Maxillofacial Surgeons”
Speakers: Dr. Ivan YING/ Dr. Teresa LO
Sleep disordered breathing (SDB) is a prevalent disease in both adults and children, characterized by
repetitive collapse and mechanical obstruction of the upper airway during sleep. Anatomical abnormality is
one of the common contributing factors. As a close neighbour of the upper airway, the anatomy of the oral
and maxillofacial structure will have a great impact on the development of SDB and its subsequent
management. The dental professionals, as the major carer of the patients with oral and maxillofacial diseases,
need to have an updated knowledge of the interplay between SDB and the maxillofacial structures, as well
as their contemporary management.

Surgical correction of the maxillomandibular complex has been shown to be one of the most effective and
reliable treatments of SDB. This presentation will share how the oral and maxillofacial surgeons contribute
their expertise and experience in jaw corrective surgery to the management of SDB. We will also share some
novel surgical techniques and their evolution throughout the past decades.
 Dr. CHAN Wing Wai Stephen
Physiotherapist, Hong Kong Children’s Hospital
BSc, MSc, DHSc PT

Dr. Stephen CHAN is a Physiotherapist of the Hong Kong Children’s Hospital. He has almost 22 years of
physiotherapy expertise, including substantial management of children patients with complex difficulties. He
has obtained training in a variety of paediatric and musculoskeletal specialties including acupuncture,
paediatric aquatic therapy, manual therapy, myofunctional therapy, and musculoskeletal ultrasonography.
He graduated from Hong Kong Polytechnic University with a Doctorate degree in Physiotherapy. His research
interests include pain management, myofunctional therapy, early rehabilitation and children's quality of life.

“Myofunctional Therapy for Patients with Sleep Disordered Breathing”

Patients with sleep-disordered breathing, particularly obstructive sleep apnoea, are more likely to breathe
via their mouth. They were also discovered to have less tongue strength, tongue mobility, and tongue
endurance. Myofunctional therapy uses a combination of physical therapy exercises to improve the bite,
breathing, and facial posture of those with orofacial myofunctional disorders. Studies found that
myofunctional therapy has been shown to decrease the apnea hyponea index by 50% and 62% in adults and
children respectively. It was also proven to be able to improve oxygen saturation, snoring and sleepiness. In
this presentation, the speaker will explain the chain reaction and adverse consequences caused by
myofunctional problems, and its impact on airway, respiratory function and body posture. The assessment
and treatment protocol of the myofunctional program will be shared in this presentation as well.