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?

Risk factors for sleep apnea during pregnancy

If you are pregnant, snoring, older age and obesity can put you at risk for sleep apnea, according to the National Institutes of Health (NIH). They completed a study that appeared in the American Journal of Obstetrics and Gynecology to look further into this connection and how risky it is for sleep apnea and pregnant women.

What are the risk factors?

An earlier study of first-time pregnancies found that sleep apnea increases a woman’s risk for hypertension and gestational diabetes. However, there are currently no medical guidelines or treatment recommendations available for sleep apnea during pregnancy. NIH’s current study, though, supports a look at treatment options for pregnancy-related sleep apnea. And, based on these results, they are planning a larger study to look deeper into this subject.

Researchers found that almost four percent of more than 3,000 women in early pregnancy and more than eight percent of over 2,500 women in mid-pregnancy had sleep apnea. The risk factors for having this condition included frequent snoring, older maternal age and being overweight as determined by body mass index (BMI).

Each woman’s risk will vary depending on their individual characteristics. However, the researchers in this study created a calculator using maternal age, BMI and snoring frequency to arrive at the woman’s probability of sleep apnea in early and mid-pregnancy.

Treating sleep apnea during pregnancy

Of course one option  available is the use of CPAP therapy. However, it is not currently known if this type of treatment during pregnancy will prevent hypertension, diabetes or other complications of sleep apnea. We can also turn to oral appliance therapy to help improve sleep apnea symptoms and potentially improve the woman’s health and well-being during pregnancy.

What is the role of sleep apnea in COPD?

Chronic obstructive pulmonary disease ( COPD ) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Obstructive sleep apnea (OSA) is a known common comorbidity of COPD. However, the relationship of the combination of OSA and COPD on mortality is not clear. It has been found that OSA occurs in about 10 to 15 percent of patients with COPD. This is often referred to as the overlap syndrome.

What is the connection?

According to the COPD Foundation, sleep-related disorders are most prevalent in adults and are associated with increased mortality and morbidity from obesity, cardiovascular diseases, diabetes and depression. As a result, so many people experience a reduced quality of life and increased health care costs.

Patients with severe COPD commonly exhibit abnormal sleep like insomnia that can contribute to daytime sleepiness and fatigue. Additionally, medications that have been used to treat COPD may affect the patient’s quality of sleep. Due to a nighttime reduction of oxygen levels that are commonly seen in patients with COPD, it can have a profound effect and lead to long-term sequelae, which can produce arrhythmias, myocardial stress and even lower survival rates.

Oral appliances for treatment

Individuals with both conditions have an increased risk of death and more hospitalizations without CPAP treatment, or in our case, oral appliance therapy. Without treatment, it can negatively impact their overall well-being. The use of oral appliance therapy helps to improve breathing for patients.

For patients with COPD, there is a very poor quality of sleep involved. And if they suffer from OSA as well, it can have profound effects. By looking further into OSA among patients with diagnosed COPD, it can potentially help improve treatment and their outlook on life. Recommend a sleep evaluation for patients diagnosed with COPD and try asking questions about daytime sleepiness, snoring, etc.

We owe it to our patients to remain up-to-date on the latest health connections with sleep apnea for improved care.