Obstructive sleep apnea affects approximately 5.9 million adults in America, with about 23.5 million cases being undiagnosed. While sleep apnea itself may seem harmless and passed off as a bad habit of snoring, it’s actually the body’s way of signaling that there is a deeper medical issue that needs to be addressed. When left untreated for long periods of time, sleep apnea can lead to diseases that are the top five causes of death among adults in the US. In fact, sleep apnea can even affect young children, leading to life-long health issues if left untreated.
The prevalence of sleep apnea and its effects have called for the disorder to be considered a public health issue in America. In the fight to help those affected by this disorder, dentists have been recruited among other health professionals to help screen for this condition to improve the lives of patients of all ages. The dentists’ role is crucial because most Americans consult or visit their dentist more often than their general internist or family doctor.
What we’ve Learned about OSA
People have been snoring for ages, and it’s not unusual for a person’s snoring to be the butt of a joke, even in pop culture! There are even euphemisms for snoring, such as “sawing logs,” “calling the hogs,” and many more just in the English language. It wasn’t until most recently that medical professionals started looking deeper into the cause of snoring and the effects it has on the body. The high number of previously undiagnosed sleep apnea cases is also likely due to the minimal focus on sleep disorder training in medical fields. Now that more emphasis is being placed on this condition, and with the alarming statistics of how many Americans suffer from OSA, numerous medical fields are implementing screening measures and training for medical staff to understand the diagnosis better.
OSA, or obstructive sleep apnea, is the most common type of sleep apnea and is a condition that causes people to cease breathing during the night, caused by an obstruction of the airway in the back of the throat. Left untreated, OSA can lead to other fatal medical issues such as hypertension, stroke, and heart disease, to name a few. Because OSA increases the morbidity and mortality rate of co-occurring health conditions, medical providers need to participate in interdisciplinary collaboration across multiple fields to better care of their patients.
Screening Protocols for OSA
The diagnostic criteria developed by the American Academy of Sleep Medicine are based on observed symptoms of OSA, along with polysomnography recordings of hypopnea and apneic episodes while test subjects were asleep. This form of testing is most effective for understanding and diagnosing obstructive sleep apnea, creating what is now referred to as the apnea-hypopnea index (AHI). The scale serves as an empirical index of the severity of a patient’s condition with a scoring of mild (5 ≥ AHI < 15), moderate (15 ≥ AHI < 30), or severe (AHI ≥ 30).
The diagnostic sleep studies are performed by specialists, but rarely does a patient go directly to a sleep medicine doctor without being referred or urged by a primary care physician or dental professional. Dentists have their own screening protocols in recognizing sleep apnea. While they cannot diagnose patients with the condition themselves, they are critical in the prescreening process that can be lifesaving for many who don’t regularly speak to their doctors about sleeping and snoring habits.
OSA Screening at the Dentist
Dental practitioners are in the perfect position to screen for obstructive sleep apnea because they frequently have access to a patient’s upper airways’ physiological structures during a routine checkup. They also tend to see patients more regularly than general practitioners or family doctors and are also already screening for health conditions before performing any procedure.
Dentists will often use the STOP-Bang questionnaire to assess a patient who shows signs or a predisposition to OSA, such as a high neck circumference and BMI, along with complaints or reports of snoring. It’s a yes or no question test that evaluates snoring, tiredness, observed apnea, and blood pressure (STOP). It also looks at BMI, age, neck circumference, and gender (BANG).
There is also a Sleep Apnea Clinical Score test that assesses neck circumference, snoring, apnea episodes, and hypertension. The Epworth Sleepiness Scale (ESS) hat ranges from zero to three (also called the Likert scale), assesses a patient’s daytime sleepiness, which is a major symptom of obstructive sleep apnea. An ESS score ≥ 11 can confirm excessive daytime sleepiness and that a patient is at high risk.
The NoSAS test is an effective and easy way to examine neck circumference, BMI, age, sex, and snoring regarding sleeping disorders, which professionals in many medical fields use. The OAAT, or the Obstructive Airway Adult Test, consisting of multiple-choice questions that help assess symptoms, apnea episodes, comorbidities, and risk factors. The scores stand as follows to reflect the degree of obstructive sleep apnea: mild (OAAT score ≥ 38), moderate (score ≥ 57), or severe (score ≥ 73).
While these tests are helpful for medical providers such as dentists, a further referral to a sleep specialist is required to designate an official diagnosis for OSA. Regardless, dental professionals are in the frontlines of helping prescreen for this potentially fatal condition with an arsenal of testing methods. With undiagnosed patients being at risk of diseases like diabetes, hypertension, cardiovascular disease, and periodontitis, dentists are providing an essential prescreening service for their patients.
Obstructive sleep apnea is nothing to sleep on! Anyone who suffers from snoring, disrupted sleep, daytime sleepiness, and other OSA symptoms should consider consulting their dentist for a preventive prescreening test. A referral to a sleep specialist and sleep study could be a lifesaving event for those unaware that their snoring or daytime sleepiness could be signs of a condition that can lead to other fatal diseases.