Quality Resource Guide –

Managing Sleep Disordered Breathing in Dental Practice 2nd Edition

www.metdental.com

Page 3

patient spent asleep. This measure represents

the severity of sleep apnea, including sleep

disruptions and desaturations. The AHI classifies

OSA into three categories (Figure 2).

Respiratory Disturbance Index (RDI) - The RDI

is also a measure of the severity of sleep apnea,

including sleep disruptions and desaturations.

Unlike the AHI, the RDI also counts the number

of arousals caused by respiratory effort. It is the

average number of Sleep Disordered Breathing

events that cause an arousal from sleep per hour

of sleep. It is calculated by adding the number of

apneas, hypopneas and respiratory effort-related

arousals and dividing this figure by the number of

hours the patient spent asleep.

Diagnosis of OSA

The diagnosis of OSA may be made when one of

the following criteria is met:

1. AHI or RDI > 5 per hour of sleep, evidence

of respiratory effort, and symptoms (extreme

sleepiness, witnessed apneas, etc.), or

2. AHI or RDI > 15 per hour of sleep, evidence of

respiratory effort, and no other symptoms.

Managing OSA in a

General Dental Practice

Why should a dentist care about

OSA?

As many as 25% of men, and 10% of women,

between the ages of 30 and 60, suffer from SDB.

Dentists typically see patients on an annual or

semi-annual basis, allowing them to play an

important role in:

• The early identification of patients with

OSA;

• Treating patients’ with mandibular

advancement devices, and;

•

Managing patients with OSA over time.

Identifying a Patient with SDB

Due to the prevalence of SDB, individuals with

undiagnosed SDB visit many dental offices for

oral health care in the United States each year.

Identifying these individuals as candidates for

therapy may require only minor modifications

in office protocol. Activities that may assist in

identifying patients with SDB include:

Create SDB Awareness:

• Add a sign and place brochures about

snoring and OSA in your waiting room

• Send a descriptive letter to existing patients

• Highlight SDB therapy in your practice

newsletter

• Send a letter to your referral network

• Send out a press release

• Add a section on SDB treatment to your

website, including patient testimonials

• Place an advertisement in a local newspaper

or magazine

Add Questions to the Medical History Form:

• Has anyone ever told you that you snore?

• Has anyone ever told you that you stop

breathing at night?

• Does your bed partner snore or stop

breathing at night?

• On a scale of 1 to 10, how sleepy are you

during the day?

• Have you ever had a sleep study?

• Has a physician ever prescribed CPAP

therapy for you?

Carefully look for clues in a patient’s Medical

History. Red flags may include:

• Hypertension or drug-resistant hypertension

• Overweight individuals or those with recent

weight gain

• Cardiovascular disease

• Diabetes

• Gastro-esophageal reflux disease (GERD)

• CPAP usage

Perform “Airway-Focused” Oral Exams.

Red flags

in an oral exam include:

•

Narrow or V-shaped upper arch

•

Cross bite in molar area

•

Soft tissue that visually obstructs airway

• Large or scalloped tongue

• Bony tori

Screening for OSA

OSA diagnosis must be by a physician, however

dentists can screen

their

patients

and

assist

in early identification of OSA by: taking careful

medical histories at the initial examination and

recalls; administering simple patient questionnaires;

interviewing bed partners; observing oral indicators,

and; assessing the patient’s risk for OSA using

appropriate tools (Table 3).

Referring a Patient to a Physician

A dentist should refer patients to their primary

care physician or a sleep physician for further

evaluation, testing and diagnosis whenever there

is a suspicion of possible OSA, or demonstrates

symptoms associated with untreated OSA (fatigue,

high blood pressure).

Treating OSA

There are many options for treating snoring and OSA,

including both nonsurgical and surgical approaches.

It is important for the patient to understand that there

is no permanent cure for OSA. They must realize

that therapy will typically continue for the rest of their

lives. According to the American Academy of Sleep

Medicine (AASM), optimal options for treatment of

snoring and sleep apnea are:

Conservative Treatments - The following measures

have been shown to improve OSA (they are also

often recommended for occasional snorers):

•

Improving sleep hygiene; (Sleep hygiene is a

variety of different practices that are necessary

to have normal, quality nighttime sleep and full

daytime alertness. The most important sleep

hygiene measure is to maintain a regular sleep

and wake pattern seven days a week.)

• Abstaining from alcohol and sedatives;

•

Avoiding sleeping on one’s back, and;

• Losing weight.

Figure 2

Mild

OSA

Moderate

OSA

Severe

OSA

AHI between

and

(with other symptoms)

AHI between

15.1

and

AHI greater than

OSA Diagnosis - AHI Classiﬁcation