Home Sleep Testing – No Business for Dentists?

Sleep apnea is a widespread sleep disorder affecting millions of Americans, yet many cases remain undiagnosed and untreated. Although the practice of screening patients with a home sleep test device by dentists is highly debated, as a board-certified sleep physician I firmly believe that dentists can play a crucial role in identifying and managing sleep apnea among the general population. In this article, we’ll explore the reasons why dentists are well-suited for sleep apnea screening and how their involvement can significantly impact patient outcomes.

Increased Access to the General Public:

Dentists interact with a diverse range of individuals on a daily basis, providing them with unparalleled access to the general public. Unlike sleep doctors who primarily see patients referred to them for sleep-related concerns, dentists have the opportunity to identify potential sleep apnea cases among individuals who may not have access to specialized sleep care. In fact, the American Dental Association (ADA) recommends that all dentists screen for obstructive sleep apnea (OSA). By integrating sleep apnea screening into routine dental visits, dentists can reach a broader population and ensure early detection of this prevalent sleep disorder.

Expertise in Oral Health:

Dentists are trained to examine patients’ oral cavities, allowing them to identify signs of anatomical factors associated with sleep-disordered breathing. Patients with narrow airways or other oral abnormalities may be at increased risk of developing sleep apnea. Dentists are uniquely positioned to recognize these risk factors and refer patients for further evaluation by a sleep physician. By leveraging their expertise in oral health, dentists trained in sleep medicine can contribute to early intervention and prevention of sleep-related complications.

Patient Engagement and Communication:

Patients often spend more time in a dental chair than they do in a sleep clinic, providing dentists with ample opportunity to engage in conversations about sleep quality and related health concerns. Patients may feel more comfortable discussing their sleep apnea symptoms with their dentist than with their primary care physician, leading to earlier detection and intervention. Dentists can educate patients about the signs and symptoms of sleep apnea and encourage them to seek further evaluation if warranted. By fostering open communication, dentists can empower patients to take control of their sleep health.

Alternative Treatment Options:

In addition to screening, dentists can provide alternative treatment options for patients with mild to moderate sleep apnea. Oral appliance therapy (OAT), prescribed by a board-certified sleep physician and fulfilled by dentists trained in dental sleep medicine, offers a comfortable and effective alternative to continuous positive airway pressure (CPAP) therapy. OAT can be used as a standalone treatment in combination with CPAP and surgical options for enhanced efficacy. By offering alternative treatment modalities,  patients may have better adherence to treatment thus may have improved health outcomesand overall satisfaction.

Treating sleep apnea is crucial due to its significant impact on both physical and mental health. Sleep apnea is a sleep disorder characterized by pauses in breathing or shallow breaths during sleep. These interruptions can occur multiple times per hour, leading to fragmented sleep and reduced oxygen levels in the body. Here’s a scientific and clinical explanation of why treating sleep apnea is essential:

• Cardiovascular Health: Sleep apnea is strongly associated with an increased risk of cardiovascular diseases such as hypertension, coronary artery disease, stroke, and heart failure. The repetitive drops in oxygen levels and sudden increases in blood pressure during apnea episodes put immense strain on the cardiovascular system, leading to long-term damage.

• Punjabi, N. M. (2008). The epidemiology of adult obstructive sleep apnea. Proceedings of the American Thoracic Society, 5(2), 136–143. https://doi.org/10.1513/pats.200709-155MG
• Somers, V. K., White, D. P., Amin, R., Abraham, W. T., Costa, F., Culebras, A., Daniels, S., Floras, J. S., Hunt, C. E., Olson, L. J., Pickering, T. G., Russell, R., Woo, M., Young, T., & American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, American Heart Association Stroke Council, American Heart Association Council on Cardiovascular Nursing, American College of Cardiology Foundation. (2008). Sleep apnea and cardiovascular disease. Circulation, 118(10), 1080–1111. https://doi.org/10.1161/CIRCULATIONAHA.107.189375

• Metabolic Health: Sleep apnea is closely linked to metabolic disorders such as obesity, insulin resistance, and type 2 diabetes. Disrupted sleep patterns and hormonal imbalances associated with sleep apnea can negatively impact glucose metabolism and contribute to weight gain.

• Tasali, E., & Ip, M. S. M. (2008). Obstructive sleep apnea and metabolic syndrome: Alterations in glucose metabolism and inflammation. Proceedings of the American Thoracic Society, 5(2), 207–217. https://doi.org/10.1513/pats.200708-134MG
• Pamidi, S., & Tasali, E. (2012). Obstructive sleep apnea and type 2 diabetes: Is there a link? Frontiers in Neurology, 3, 126. https://doi.org/10.3389/fneur.2012.00126

• Neurocognitive Function: Chronic sleep fragmentation and oxygen desaturation in sleep apnea can impair cognitive function, memory consolidation, and daytime alertness. These consequences can result in poorer daytime functioning such as decreased productivity, impaired concentration, and an increased risk of motor vehicle and workplace accidents.

• Beebe, D. W., Groesz, L., Wells, C., Nichols, A., & McGee, K. (2003). The neuropsychological effects of obstructive sleep apnea: A meta-analysis of norm-referenced and case-controlled data. Sleep, 26(3), 298–307. https://doi.org/10.1093/sleep/26.3.298
• Bucks, R. S., Olaithe, M., Eastwood, P., & Hillman, D. (2013). Cognitive dysfunction in obstructive sleep apnea: A review of the literature. Sleep Medicine Reviews, 16(5), 441–454. https://doi.org/10.1016/j.smrv.2011.12.003

• Quality of Life: Untreated sleep apnea can significantly impact an individual’s quality of life, leading to excessive daytime sleepiness, mood disturbances, and decreased overall well-being. Effective treatment can improve sleep quality, enhance daytime functioning, and reduce the risk of associated comorbidities.

• Weaver, T. E., & Grunstein, R. R. (2008). Adherence to continuous positive airway pressure therapy: The challenge to effective treatment. Proceedings of the American Thoracic Society, 5(2), 173–178. https://doi.org/10.1513/pats.200708-119MG
• Engleman, H. M., & Douglas, N. J. (2004). Sleep. 2: Physiology and Functions. British Medical Journal, 329(7468), 277–280. https://doi.org/10.1136/bmj.329.7468.277

Treating sleep apnea is crucial for mitigating its adverse effects on cardiovascular health, metabolic function, neurocognitive performance, and overall quality of life. Effective management strategies, including continuous positive airway pressure (CPAP) therapy, oral appliance therapy, and/or surgical options and lifestyle modifications, are essential for improving patient outcomes and reducing the risk of comorbidity and mortality.

Conclusion:

In conclusion, dentists are well-positioned to play a significant role in the screening and management of sleep apnea. Their increased access to the general public, expertise in oral health, and ability to engage patients in meaningful conversations make them valuable allies in the fight against this prevalent sleep disorder. By working together with board-certified sleep physicians, dentists can ensure that patients receive timely and appropriate care for sleep apnea. It’s time to harness the collective expertise of healthcare providers and combat sleep apnea on all fronts.

Additional References:

• American Academy of Dental Sleep Medicine. (2021). Dental Sleep Medicine: Overview. Retrieved from https://aadsm.org/
• Peppard, P. E., Young, T., Barnet, J. H., Palta, M., Hagen, E. W., & Hla, K. M. (2013). Increased prevalence of sleep-disordered breathing in adults. American Journal of Epidemiology, 177(9), 1006-1014.
• Aurora, R. N., Kim, J. S., Crainiceanu, C., O’Hearn, D., & Punjabi, N. M. (2018). Habitual sleep duration and all-cause mortality in a general community sample. Sleep, 41(5), 1-9.
• American Dental Association – https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/oral-health-topics/ada_2019_policy_role_of_dentistry_sleep_related_breathing_disorders.pdf?rev=a6b7d4ff667c4325bd1cc402882e0235&hash=1FF15BB2D17D9EA639120DBB78D660E3

By Haramandeep Singh, MD, D. ABPN

Source: SleepWorld Magazine March/April 2024

Board Certified Sleep Medicine & Psychiatry

Dr. Haramandeep Singh is a board-certified sleep physician licensed in all 50 states and CEO of iSleep Physicians, which offers sleep interpretations and telemedicine in all 50 states for both pediatric and adult patients.

Disclosure: Speaker consultant for Jazz pharmaceuticals, Axsome Therapeutics and Avadel Pharmaceuticals.