It’s all about the sleep apnea facts

As dentists, we want to know everything we can about how to treat our patients. And as dental sleep medicine specialists, that means the sleep apnea facts. To help you better understand the needs for providing our patients with sleep apnea treatment, I have compiled some helpful–and interesting–facts.

Here are some sleep apnea facts you can bring back to your team and your patients.

Undiagnosed sleep apnea

Despite having clear signs and symptoms, many patients with obstructive sleep apnea go undiagnosed. The negative effects of not treatment sleep apnea are evident:

  • On average, a patient goes 7 years without proper treatment.
  • During those 7 years, patients visit their family physician about 17 times and subspecialists about 9 times.
  • Undiagnosed sleep apnea causes worsening of symptoms and health conditions.

Health complications exist

Comorbidities of sleep apnea have been shown to include a number of health conditions, including:

  • High Blood Pressure
  • Heart Disease
  • Type 2 Diabetes
  • Acid Reflux
  • Obesity

Performance, safety and quality of life

Sleep loss and sleep apnea affect an individual’s performance, safety and quality of life – causing a financial burden on healthcare and productivity.

  • Almost 20% of all serious car crash injuries in the general population are associated with driver sleepiness.
  • When sleep apnea is not treated, it is far more costly than it would be to deliver adequate treatments.
  • Each year, hundreds of billions of dollars are spent on direct medical costs.
  • Compared to healthy individuals, those who suffer from sleep loss and sleep disorders are less productive.
  • Today, most patients do not go under surgery for treatment. Instead, most are treated with an oral appliance as the leading form of sleep apnea treatment due to their convenience and ease of use.
  • The availability of custom-made oral appliances ensures accuracy and the best results.
  • The largest numbers of patients that suffer from sleep apnea are in the mild to moderate categories, which should be treated with oral appliances.
  • Understanding the importance of oral appliance therapy is vital in the treatment of sleep apnea.

Incorporating sleep apnea treatment into your practice, helps improve the services you offer in addition to helping improve your patients’ overall health.

Reintroducing the dental team for sleep apnea care

We have discussed this in the past, but I think it is time to bring this back to the surface. It is time to reintroduce the dental team for sleep apnea care! When it comes to providing your patients with dental sleep medicine services, it is important to understand that this isn’t a one person job. It requires a team-based care approach, which means every dental team member plays a role in sleep apnea care.

Dentist you play a vital role in dental sleep medicine, but each member of your dental team also needs to evolve with the new roles and responsibilities to help patients with obstructive sleep apnea (OSA).  From the receptionist and billing coordinator to the hygienist and dental assistant, the office plays an integral role in the screening and managing for potential patients who might not know they suffer from OSA.

Let’s take a look at the dental team for sleep apnea care and each person’s role at your dental office:  

The front office

The first member of the dental team for sleep apnea care is the front office staff. This is the face of your office because they are the ones who greet your patients at every visit. There are two pathways for patients: One is identifying a patient in the dental office and sending out for a diagnosis, while the other is referred in from a sleep doctor or advertising efforts. Remember, if they come to the dentist for services, then an order from a physician is required before oral appliance fabrication can be completed. Due to this, the front office holds an important role and must fax a request or educate the patient of the need for a referral from a sleep physician. Beginning with the initial phone call, the front office team will ask patients that are referred to the office to bring a copy of their sleep study, medical insurance information and any other important information needed.

The billing coordinator

Once a patient is a candidate for oral appliance therapy, verification and, in some cases, predetermination is initiated to determine benefits of coverage for treatment. This is where the billing coordinator steps in. The billing coordinator is essential in the treatment process to ensure every patient receives the appropriate benefits they deserve as determined by their insurance. By obtaining proper training , the billing coordinator can establish proper referral, communication and medical billing protocols—more than just completing and sending claims.

The hygienist

Hygienists are looking for and eradicating periodontal diseases, while improving their patients’ overall oral health. At the same time, hygienists perform an array of other dental duties, including looking for cavities, oral health education and screening for oral cancer. As the first person your patients meet once in the dental chair, hygienists offer recommendations based on a patient’s individual needs, which might include advice on screening to rule out a sleep breathing issue.

While obstructive sleep apnea is not the first thing that comes to mind when visiting the dentist, the area of dental sleep medicine continues to advance. Initial screenings might identify patients that snore, feel tired all the time or know someone who had been diagnosed with sleep apnea, yet never sought treatment. By screening and asking questions, dental hygienists will bring their findings to the dentist for further discussion—creating an opportunity for treatment and the possibility of a referral to a sleep physician.

The dental assistant

Working closely with the dentist is the dental assistant. The role of the dental assistant is just as important as the dentist. In this role, you will help the dentist by charting his findings, getting impressions and assisting in capturing the bite–this is the starting position for the oral appliance. Once the oral appliance is delivered to the office, the dental assistant will fit the device or assist the dentist in fitting the appliance, providing instruction, and informing patients on when and how to wear it.

The dentist

This is the main person on the dental team for sleep apnea care. As the dentist you have two roles in dental sleep medicine. After examination, to discuss with the patient that they may have a condition that needs to be tested; and determining if a patient is a candidate for oral appliance therapy. With two roles, dentists’ will either be recommending that patients visit a sleep doctor for diagnosis or treatment be based on a referral from a medical doctor, which is where the front office staff comes into play. If a patient is a candidate for oral appliance therapy, then the dentist will educate each patient on oral appliance therapy.

Each member of the dental team plays a vital role in implementing Dental Sleep Medicine. From the dentist to the front office staff, it is important to understand and execute your new roles when providing dental sleep medicine services for patients. With the unique opportunity to diagnose and treat sleep apnea, dentists should consider continuing education not only for themselves, but their entire dental staff as well.

You can take the next step toward healthy, happy patients be educating them on the different roles in dental sleep medicine.

Sleep apnea may predict mortality risk

It appears that the duration of abnormal breathing events may be a better predictor of mortality risk in both women and men. Patients with sleep apnea who have short interruptions in breathing while they sleep are at a higher risk for death than those with longer interruptions. This new information was found in a study published in the American Journal of Respiratory and Critical Care Medicine.

By understanding this new information, it can help dentists and physicians better prevent long-term mortality associated with obstructive sleep apnea. For those who have a sleep apnea diagnosis, it is linked to high blood pressure, heart disease and, now, an increased risk of dying.

Apnea-hypopnea index for severity

Sleep specialists refer to the apnea-hypopnea index (AHI) to determine the severity of sleep apnea. The severity of the AHI measurement can be linked to mortality and heart disease. However, AHI remains a coarse measurement of sleep apnea severity and is not a good risk predictor for women–AHI is largely based on data from men.

In this new study, not only does it matter how many breathing interruptions occur, but also how long each one lasts. Patients with the shortest apneas were 31 percent more likely to die during the study’s decade of follow-up with participants. This was true for both male and females.

Treating sleep apnea

The most common treatment for sleep apnea is a continuous positive airway pressure machine. However, many patients find that wearing a mask during sleep is uncomfortable. When this is the case, they choose not to use it, which can worsen sleep apnea symptoms.

Even if a patient only has mild or moderate sleep apnea, it is important for both men and women to undergo treatment. Short breathing interruptions require further attention and commitment to treatment.

Treating sleep apnea: The role of dentists, primary care physicians

Obesity is a global epidemic well rooted in the U.S. and Western cultures. With recognition of the magnitude of this epidemic, it is important to promote obesity prevention by all health professions and disciplines. This will help to prevent further health complications, such as diabetes, heart disease and obstructive sleep apnea, as well as other sleep-related breathing disorders (SRBD).

When a person struggles to breathe during sleep, or stops breathing, additional stress is placed on the heart, leading to health risks. To further improve the health of our patients, dentists should work with primary care physicians (PCP). Here is why.

Screening for sleep apnea

Dentists and primary care physicians are the first line of detection and treatment for their patients. As a dentist, you see your patients more frequently than physicians. This is especially true when patients adhere to the recommended cleaning every six months. PCPs  often see their patients more frequently than physician specialists, such as cardiologists, neurologists, pulmonologists, etc.

Both dentists and PCPs have the opportunity to discuss a variety of concerns that affect their patients’ quality of life, well-being and potential health risks. A large number of patients with undetected and untreated sleep disorders pass through dental and PCP offices each day. For this reason, it is important to complete advanced training and continuing education courses. This will help you to better understand how best to embed practical assessments and referrals into routine care.

Dentists and PCPs should work with a referral system. This links the patient with a proper specialist for diagnosis, as well as treatment. They can also educate and consult the patient about healthy lifestyle choices to reduce risk factors associated with obesity and SRBD.

Evidence-based treatment of sleep apnea

After a diagnosis is made, the medical sleep specialist can recommend treatment. Possible treatment might include weight loss, positional therapy, continuous positive airway pressure (CPAP), oral appliance therapy or surgery. Combination therapy is also common to provide individualized treatment for the patient. This often includes CPAP with oral appliance therapy. When a dentist receives proper training and credentialing, they can effectively treat patients using oral appliance therapy.

Patients should receive ongoing reinforcement for healthy behaviors during routine office visits. This is regardless of the treatment or health professional overseeing treatment.