For Dentists

A Growing Epidemic with an Effective Dental Solution

sleep disorderMore than 18 million Americans suffer from obstructive sleep apnea (OSA), and in many cases go untreated for the condition. The awareness of OSA as a significant, potentially life-threatening, medical problem is growing for a number of reasons: the percentage of the population at risk of OSA increases as the average US adult, and child, population increases in weight and clinical studies are published more and more frequently that not only identify the link between general good health and sleep but also links the presence of OSA with Cardiovascular issues such as Hypertension, Stroke and Arrythmias, Type II Diabetics, Gastro Esophageal Reflux Disease, higher risks of mortality in pregnant women with OSA, Ophthalmic conditions and more are found as awareness increases.

While OSA is a significant medical problem, there is a very viable and recognized dental therapy solution – Mandibular Advancement Devices. Since OSA is caused by the soft tissue obstruction of the airway, primarily in the oro-pharyngeal portion of the upper airway, advancement of the mandible has been shown to reduce and often eradicate the obstruction that causes the absence of breath (Apnea) or significant reduction in airflow (Hypopnea), which results in blood oxygen desaturation.

For many years dentists have been prescribing and making intra-oral appliances to treat a variety of conditions including the correction of skeletal discrepancies, the relief of muscular pain or for the protection of the dentition. There is growing awareness that some of the conditions that dentists find to be common in their practice, such as bruxism, are linked to OSA and thus one should be aware of how oral appliance therapy might affect the presence or severity of OSA.

A Dire Need – Improved Identification and Access to Diagnosis

There is no question that the subject of Sleep and its effects on our health and daily life, is gaining more and more attention, and rightly so. OSA is the most common form of Sleep Disordered Breathing, which in turn accounts for the majority of Sleep Related Disorders. Undiagnosed Sleep Apnea (SA) patients use $200,000 more in healthcare resources in the two-year period prior to diagnosis, and a 226% increase in health care use in the year before evaluation and treatment. The total economic cost of “Sleepiness” is approximately $43 – 56 billion. These figures will only grow as the at-risk population increases in number.

The detection of Obstructive Sleep Apnea requires only the measurement of 4 channels of data – respiratory effort, respiratory air flow, pulse and blood oxygen saturation, for diagnosis. Traditionally, before the approval of Portable Home Sleep Monitoring devices, the identification of OSA was left to specialist physicians using PolySomnoGraphy (PSG), an overnight Sleep Technician monitored study in a specialized sleep laboratory facility to make a diagnosis. Here, the patient undergoes a study measuring over 21 channels of information requiring extensive monitoring and equipment. This is a costly undertaking and more importantly a barrier for patients, who do not take the test due to having to sleep away from their natural environment.

Home Sleep Testing, using approved Portable Monitoring devices, has reduced the major barriers to identifying OSA. A simple device, measuring the 4 channels above and snoring events that might prevent getting restful sleep, that can be used and applied simply by most patients in the comfort of their own home, allows both the practitioner and patient to effectively identify this condition, for a fraction of the cost and far less inconvenience than traditional PSG lab tests.

A therapy dilemma or cry for help?

sleep apnea 3OSA is effectively treated by two therapies – Positive Airway Pressure (PAP) therapy, and Oral Appliances (OA) – with neither being a panacea and each having its benefits and pitfalls. The choice of which therapy is used should be predicated on what is best for the individual sufferer in terms of handling the severity of the condition and their tolerance for each modality. With physicians favoring PAP therapy and established by the AASM as the “Gold Standard” in treating OSA, dentists have the task of educating their fellow physician practitioners on role that Oral Appliances can play in the effective management of OSA.

Studies show that more than 30% of patients prescribed PAP therapy never initiate treatment and further, 15% of those that do start treatment, abandon therapy after 10 – 15 months. The reasons for this are complex and require their own research and correction, but suffice to say, patients are reluctant to wear the PAP machine paraphernalia and may have difficulty adapting to forced airflow. Conversely, studies show 75 – 100% compliance with oral appliances up to 2 years and 75 – 90% up to 5 years.

However, prior to Home Sleep Testing, with the only path to OSA diagnosis through physician-centric sleep laboratories, unfamiliar with OA therapy and the role they can play in OSA management, many dentists found the patients they referred to a sleep lab ending up on PAP therapy without an objective discussion on the relative merits of each therapy.

There is probably little disagreement amongst physicians and dentists that instruction and training in each other’s proficiencies is limited and a greater understanding of each therapy and an inter-disciplinary approach to managing a patient’s condition might lead to better outcomes.

The Dentist’s Role in tackling the OSA epidemic

DoctorSince the population is more tuned to seeing their dentist / dental hygienist on a more regular basis than their physician, in the absence of a specific problem, dentists and dental hygienists are well positioned to screen and identify these potentially deadly condition. As a result, you have patients in your office right now who are either undiagnosed for OSA or may be non-compliant with PAP (CPAP) therapy.

Traditionally, diagnosing the disorder could be inconvenient and costly because an overnight sleep study in a sleep lab or hospital was required to do so. Blackstone Medical Services has a solution for dentists and patients: we provide innovative home diagnostic testing for OSA that solves many of the problems providers currently face. Our testing services provide patients with better access to testing as they can complete these tests in the comfort of their own home, at a fraction of the cost of lab or hospital facility based studies.

Patient compliance is often thought to be difficult to monitor with an unattended at-home study compared to overnight monitored testing. This is one of the primary reasons many dentists are hesitant to prescribe an at-home test. But it’s not the case. A 2013 study in the journal Sleep Review found that “the home testing pathway is not clinically inferior to the traditional PSG pathway.” Their findings have been confirmed in studies that looked at specific patient populations including those published in Respiratory and Critical Care Medicine in 2012 and 2014. The overwhelming body of clinical evidence supports at-home OSA diagnosis as an effective measure.

Managing in-office OSA testing devices – with the emergence of Dental Sleep Medicine, HST device manufacturers approached dentists to buy their own devices. Many dentists bought their own testing devices only to find that managing these devices lead to significant problems such as needing a dedicated staff person to manage devices, ongoing supply costs, device loss or damage and patient delays in returning devices to name but a few, that lead to greater costs without the implied benefits to the bottom line.

Our experience, having spoken to many offices that have bought their own devices, is that trying to maintain one’s own devices leads to more resistance to testing rather than making this a more simple and efficient testing method for both the office staff and the patient. Leave the problems of device inventory loss or damage and delays in return to Blackstone Medical Services so that your staff can concentrate on the duties that give you greater return.

In addition, Blackstone Medical Services is a JCAHO, AHCA and Medicare accredited Independent Diagnostic Testing Facility. Utilizing our testing process allows separation of testing from therapy.

Finding Sleep Doctors if your patient does not have a Primary Care Physician or you need to consult with a Sleep Specialist, depending on your location, we may be able to connect you with a PCP that is familiar with treating sleep or a Sleep Specialist in your area.

The Preferred Choice HST Service At Blackstone Medical Services, we understand the challenges that dentists face in diagnosing and treating OSA. Partnering with us reduces the barriers to testing that your patients face in terms of convenience and cost, without loss of accuracy, which in turn results to more opportunities to help patients receive the care they need and to stay on treatment for this potentially life threatening condition.

If you need more information about how OSA is affecting your patients, visit any one of the links below. And if you’re ready to begin helping your patients with the highest in HST excellence, Blackstone Medical Services is ready to assist you. Contact us today to learn how.

Sources:
http://www.sleepreviewmag.com/2013/02/home-sleep-testing-versus-in-lab-polysomnography/
http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A6437
http://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A3591