How to Screen Your Patients for Sleep-Related Breathing Disorders

Sleep-related breathing disorders (SRBDs), such as obstructive sleep apnea (OSA), are increasingly recognized as critical health concerns that can significantly impact patients’ quality of life. As a dentist, you are uniquely positioned to identify signs of SRBDs during routine dental exams. However, effectively screening and managing these conditions requires additional training beyond dental school. This article outlines the essentials of SRBDs, their prevalence, screening tools, and how dentists can collaborate with medical professionals to improve patient outcomes.  

Understanding Sleep Apnea

Sleep apnea is a condition where a person’s breathing repeatedly stops and starts during sleep. For an event to qualify as apnea, breathing must cease for at least 10 seconds. Obstructive sleep apnea (OSA), the most common form, occurs when the airway becomes partially or completely blocked, often due to relaxed throat muscles or anatomical factors.  

Prevalence and Relevance to Your Dental Practice

SRBDs are more common than you might think. Approximately 1 in 4 patients in your dental practice may be suffering from some form of SRBD, including OSA. In the U.S., an estimated 17-31% of adults have OSA, with many cases undiagnosed. This high prevalence means dentists are likely to encounter patients with SRBDs regularly, making screening a critical part of patient care.  

Common Symptoms of Sleep Apnea

Recognizing the symptoms of sleep apnea is the first step in identifying at-risk patients. Common signs include:

• Snoring: Often loud and disruptive, a hallmark of OSA.
• Choking or Gasping During Sleep: Patients may wake abruptly due to airway obstruction.
• Excessive Daytime Sleepiness: Difficulty staying awake or alert during the day.
• Fatigue and Lethargy: Persistent tiredness despite adequate sleep time.
• Depression/Anxiety: Mood changes linked to poor sleep quality.
• Un-refreshed Sleep: Waking up feeling unrested, even after a full night’s sleep.

 

Gender Differences in Symptoms

Symptoms can vary between genders, which is important for accurate screening:

• Males: More likely to exhibit snoring, observed apneas, or excessive sleepiness.
• Females: More likely to report depression or morning headaches.

  Dentists should be cautious when patients, especially females, report morning headaches. While a night guard is a common response, it may not address the underlying issue of SRBD, which could be the root cause.  

Risk Factors for Untreated OSA

Understanding the risk factors for OSA helps in identifying patients who need screening. These are divided into modifiable and non-modifiable factors:

Modifiable Risk Factors

• Obesity: Excess weight can contribute to airway obstruction.
• Drug Use: Opiates and benzodiazepines can relax airway muscles.
• Alcohol Intake: Suppresses pharyngeal dilator muscle activation, worsening airway collapse.
• Smoking: Causes upper airway edema, increasing obstruction risk.
• Supine Sleeping Position: Sleeping on the back can exacerbate airway collapse.
• Nasal Congestion or Obstruction: Oral breathing increases the likelihood of apnea.

 

Non-Modifiable Risk Factors

• Male Gender: Men are at higher risk.
• Menopausal Status: Post-menopausal women are 2.6 times more likely to have SRBD due to reduced estrogen, an airway protector.
• Craniofacial Abnormalities: Structural issues like a retrognathic mandible.
• Genetic Inheritance: Family history increases risk.
• Race: Certain ethnic groups have higher prevalence.
• Aging: Loss of muscle tone with age increases risk.

 

Dental Signs and Symptoms

Dentists can identify potential SRBDs through clinical observations during exams. Look for:

• Vaulted palate
• Large tongue
• Worn enamel
• Abfraction lesions
• Mandibular tori
• Retrognathic mandible
• Lateral tongue scalloping
• History of TMJ disorder
• Bruxism
• Morning headaches
• Pain in the temple and masseter muscles

  These signs, combined with patient history, can prompt further investigation into SRBDs.    

Implementing Screening Tools in Your Practice

Screening for SRBDs should be a routine part of your dental practice. Here’s how to integrate effective screening tools:

Intake Forms

Incorporate questions about sleep health into your patient intake forms. These provide starting points for discussions and are often required by insurance providers when filing for mandibular advancement device (MAD) reimbursement. Useful tools include:

• Epworth Sleepiness Scale (ESS): Measures daytime sleepiness.
• STOP and STOP-BANG: Assesses risk through simple questions about snoring, tiredness, observed apneas, and other factors.
• Basic Questions:
  • Do you snore?
  • Do you have difficulty falling or staying asleep?
  • Are you frequently tired during the day?
  • Are you aware, or have you been told, you stop breathing during sleep?
  • Is your sleep non-refreshing?

 

Medical History Review

SRBDs are linked to conditions like headaches, cardiovascular diseases, hypertension, diabetes, asthma, allergies, and depression. Reviewing medical history can help identify patients at risk.

Airway Evaluation

During clinical exams, assess the airway for:

• Straw vs. Hose Airway: A narrow “straw-like” airway is more prone to collapse than a wider “hose-like” airway.
• Scalloped Tongue: Indentations along the tongue’s edges suggest airway pressure.
• Soft Palate: A low-hanging or elongated soft palate can contribute to obstruction.

 

Patient Education

Educate patients about SRBDs and how you can help. Provide brochures, demonstrate airway models, or discuss treatment options like MADs to engage patients in their care.  

Next Steps After Screening

Dentists cannot diagnose SRBDs; this must be done by medical professionals. If screening suggests a patient may have an SRBD, refer them to a physician for testing and diagnosis. Home sleep tests and virtual consultations through telemedicine companies can streamline the process, improving access to care and simplifying the patient journey.

Collaborating with Medical Colleagues

To provide efficient care, dentists should build strong relationships with sleep specialists and primary care physicians. Effective collaboration includes:

• Sharing screening results and clinical observations.
• Coordinating referrals for sleep studies or consultations.
• Discussing treatment options, such as MADs, which dentists can provide after a medical diagnosis.
• Utilizing telemedicine to facilitate testing and follow-ups, ensuring a smoother patient experience.

 

Final Thoughts

Sleep apnea is often called a “silent killer” because its consequences—heart attack, stroke, diabetes, and more—may not be evident until significant damage has occurred. By incorporating SRBD screening into your dental practice, you can help identify at-risk patients, guide them toward testing and treatment, and ultimately contribute to healthier, more refreshed lives. Take the first step today: screen your patients, collaborate with medical colleagues, and make a difference in your community.   For more information related to this article, watch Dr. Mayoor Patel’s webinar recording with Dental Sleep Practice linked here.