Patient adherence rate to sleep study referrals

Let’s talk about patient adherence. I think this is an area that we often overlook and really don’t pay too close attention to, but it is so important to better understand this. Patients become non-adherent for a variety of reasons and it is our job to make sure we know why this is happening so we can improve outcomes.

A study from 2017 looked at the facilitators and barriers to referral compliance among dental patients at risk for obstructive sleep apnea. The goal of this study was to determine the adherence rate to dentist referrals for sleep apnea evaluation. It also looked at the barriers and facilitators to referral compliance.

What the study found

Researchers looked at a sample of 1,099 patients that were given the STOP-Bang questionnaire. Based on the results from this questionnaire, those with elevated risk were referred for a sleep evaluation. After the referral, an interview was completed over the phone to determine if those patients followed through with the recommendation to determine compliance.

The study found that of the almost 1,100 patients screened, 224 (20 percent) were determined to be at-risk for obstructive sleep apnea. However, only 41 of those with an increased risk actually adhered to the referral recommendation. So only 18 percent actually followed through with what was recommended. That isn’t good.

It was found that the most common facilitators to compliance were increased awareness about OSA and dentist recommendation. The most common barriers to compliance were misconceptions about OSA and work responsibilities.

What can we do?

With only a small percentage of patients adherent to the recommendation of their dentist to see a sleep specialist, we need to do something. As dentists we should provide increased awareness about OSA, so that our patients better understand the importance of treatment for the improvement of their health and well-being. By providing better education, our patients can understand just how serious of a condition OSA really is. As far as work responsibilities go, we can look into home sleep testing and inform them that they can work with the sleep specialist to find the best solution.

Continue to educate your patients and staff so that you can not only improve your patients’ health but their adherence as well.

Tell your patients driving while drowsy is dangerous

Driving while drowsy means our patients are about eight times more likely to cause an accident. These federal estimates were found in a study by the AAA Foundation for Traffic Safety. In their study, they used in-vehicle camera footage of thousands of drivers that agreed to participate. After reviewing the cameras and results, the study found that drivers are falling asleep at the wheel at an alarming rate. It’s more than we thought.

With more than 700 crashes examined in the study, about 9.5 percent were caused by a drowsy driver. Drowsiness also played a role in almost 11 percent of accidents that caused serious property damage. This means we need to educate our patients more than ever before about the detrimental effects of sleep apnea not only on their health, but their surroundings.

Encourage patients to get more sleep

If a patient just isn’t sleeping, tell them to get more sleep. The AAA Foundation recommends getting at least seven hours of sleep a night before driving. While that sounds like a great idea, it isn’t always going to happen. In fact, about 35 percent of U.S. drivers actually sleep less than seven hours a night according to the Centers for Disease Control and Prevention.

And if you sleep for just four or five hours, it can quadruple your risk for an accident. However, if the patient has sleep apnea, that might be a different story when it comes to getting enough sleep each night.

Provide treatment for sleep apnea

Part of the issue is that many of patients need a lifestyle change to be able to sleep more, while others suffer from sleep apnea and don’t even realize it. Sleep apnea can make our patients feel sleepy enough to be drowsy drivers. Even if they stop the car and take a short nap, odds are they will still feel tired.

Patients that suffer from sleep apnea and are often found driving can experience altered senses that are commonly used to drive safely. It will often be difficult for them to focus their eyes, remain alert and to react quickly during various driving situations.

To combat this, it is important to not only educate our patients on the risk of untreated sleep apnea, but to also be able to identify signs and symptoms so we can recommend proper treatment or a sleep physician for diagnosis.  

What are you doing to help your patients get the sleep they need to function daily?

Untreated Sleep Apnea is Linked to Metabolic and Cardiovascular Stress

A new study in The Journal of Clinical Endocrinology & Metabolism shows that if sleep apnea is left untreated, even for just a few days, can increase blood sugar and fat levels, stress hormones and blood pressure. This study also adds support for the consistent use of CPAP, which can lead us to discussing the further importance of oral appliance therapy for those that are CPAP non-compliant.

An improved study, results

Previous studies focusing on metabolic and patients with OSA, typically collected data while participants were awake. As a result, this only showed us one area of how OSA affects a person’s overall health and wellbeing. In this new study, participants slept in a sleep laboratory at the Johns Hopkins Bayview Medical Center. Here, their brain waves, blood oxygen levels, heart rates and breathing were recorded every night. Their eye and leg movements were also observed and recorded.

Blood samples were taken from 31 patients with moderate to severe OSA and had a history of regular CPAP use for two nights. Samples were drawn every 20 minutes starting at nine at night until six in the morning. The researchers found that CPAP withdrawal caused:

  • Recurrence of OSA associated with sleep disruption.
  • Elevated heart rate.
  • Reduced blood oxygen.

This withdrawal also led to increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA was in a participant, the more these areas increased.  

Importance of treatment for sleep apnea

While this study emphasized the importance of CPAP therapy for OSA patients to prevent metabolic and cardiovascular consequences, this can be the same for oral appliance therapy. This is especially true for OSA patients who have a hard time tolerating CPAP. ORal appliance therapy can help provide proper treatment for OSA while also preventing complications.

As dental sleep medicine specialists, we have the unique opportunity to provide our patients with treatment that works and is comfortable. Let’s continue to remain ahead of the treatment of sleep apnea with oral appliance therapy and the benefits it continues to offer.

 

Women Have Trouble Sleeping

Millions of Americans have a hard time falling or staying asleep at night. This is especially true for women more than men. According to a professor at the Yale School of Medicine, insomnia is more common in females and can begin early on in women in their teens or 20s.

Research has shown that women are more likely than men to experience insomnia and other sleep disorders. In fact, they are about 1.5 times more likely to have insomnia. A 2006 Canadian study found women were 1.3 to 1.8 times more likely than men to have insomnia. And in a 2007 National Sleep Foundation poll of Americans, 60 percent of women between the ages of 18 and 24 only got a good night’s sleep a few times a week while 52 percent of men only had a good night’s sleep a few days a week.

Why is this the case?

Women have a greater likelihood of developing insomnia and other sleep disorders because of tremendous changes in hormonal levels experienced from the time they begin menstruating to menopause. Pregnant women may also have trouble sleeping due to increased urination, restless leg syndrome, acid reflux, leg cramps and other discomforts. And for women going through menopause, their sleep can be disturbed by hot flashes and night sweats that might last for years.

It is also possible for women to be kept up at night due to non-hormonal factors. For example, more men snore. That means more women have to listen to that snoring, which can make falling asleep even more difficult. Additionally, men are more likely to have obstructive sleep apnea, which can interrupt women during sleep due to pauses in breathing and potential snoring.

The reasons for insomnia and other sleep disorders needs to be explored. It also needs to go beyond just offering sleep aids. Additionally, many people might self-medicate with alcohol, which as you know, can worsen symptoms of sleep apnea and cause even more inconsistent sleep.

We need to help our patients get a better night’s sleep every night, no matter what their sleep disorder is. By asking the right questions and paying attention to their complaints, you might be just what they need to begin their journey toward healthy sleep and wellbeing.