In the UK, it’s estimated that more than 1.5m people have sleep-disordered breathing, including obstructive sleep apnoea (OSA). It is characterised by the intermittent cessation of breathing whilst asleep.
Many patients are unaware that they have this debilitating condition, unable to recall waking during the night but exhibiting daytime symptoms such as, but not exclusive to, waking unrefreshed. Snoring is a common symptom of OSA, and it is important that OSA is diagnosed and treated, as it can lead to serious medical comorbidities and reduced lifespan if left untreated. In addition, untreated OSA could lead to the development of high blood pressure, increased risk of stroke, type 2 diabetes, heart disease, and depression, as well as neurocognitive disorders such as dementia. Additionally, it can make staying awake and concentrating during the day very difficult due to increased tiredness and reduced cognition.
Can dentists diagnose OSA?
Whilst dentists are not qualified to formally diagnose sleep apnoea, dental professionals are often the first to notice signs and symptoms. As part of routine dental appointments, practitioners should examine the patient’s maxillo-facial and oral anatomy, allowing them to recognise the risk factors for OSA, such as a narrow airway, large and/ or scalloped tongue, a retrognathic jaw and possibly underlying sleep bruxism. Any signs of a restricted airway, be it from a large tongue or enlarged tonsils, should be a cause for concern and prompt you to screen the patient for any potential sleep and/or breathing disorders, including snoring and OSA. In view of this, dentists should be able to advise patients of their risk of OSA and manage them accordingly.
This is a great chance to ask simple screening questions, which might help to identify patients with disrupted sleep. Alternatively, practices could include a few questions which relate to breathing and sleep quality in the medical questionnaire completed by patients prior to visiting the practice. This can enable you to gather relevant information to indicate whether they may need a targeted sleep disorder assessment.
During an assessment, clinicians should check for any signs of obstructive sleep apnoea. These may include:
- Indentations in the tongue which might indicate an enlarged tongue
- Large tonsils which may block the airway
- Obesity and a large neck which might make restrict the airway
Making note of these signs can help practitioners form a diagnosis and form a basis for referral to a specialist.
Working within scope of practice
It is important that dental professionals work within their scope of practice. If a dental professional suspects that a patient may have OSA and they are not qualified to offer any help, it is vital that they refer patients to a qualified healthcare professional or a sleep clinic for further investigation. Whilst it is not within a dentist’s remit to diagnose medical conditions, it is important to refer patients for a sleep test, or carry one out if the clinicians has had the appropriate training. Once completed, sleep tests must always be reported to a sleep physician or physiologist for a formal diagnosis and preferably a prescribed treatment from the sleep specialist.
Following diagnosis, an appropriately trained clinician can treat patients using a mandibular advancement device (MAD).
Depending on the diagnosis, recommended courses of treatment may differ. For some, especially those who experience significant daytime sleepiness, continuous positive airway pressure (CPAP) is considered the ‘gold standard’ of care. If the patient, however, is resistant to CPAP follow.
Offering treatment for each individual
O2Vent is a solution for patients who require an alternative OSA treatment type. It is customised to fit each patient’s unique anatomy, ensuring maximum comfort. Its innovative design enables air to travel through the device, to reach the back of the throat. Additionally, it advances the mandible for an improved position to enable the airway to remain open during sleep.
It is vital that clinicians work within their scope of practice when caring for patients with obstructive sleep apnoea. This means looking out for the signs and symptoms of OSA, asking patients targeted questions, and referring patients for further investigations when appropriate.
Once a diagnosis has been established, trained clinicians should support patients and offer advice regarding the most suitable course of treatment for them. This will allow patients to receive the treatment they need, and help to prevent the development of more serious health conditions in the long term.
References available on request.