INCORPORATING SLEEP APNEA APPLIANCES INTO YOUR DENTAL PRACTICE: FROM SCREENING YOUR PATIENTS TO BILLING INSURANCE CRAIG PETTENGILL, D.D.S. May 30, 2014 OVERVIEW • Basic Sleep Physiology • Appliances • Screening Dental • Appliance Patients Complications • HST/Lab testing • Insurance BASIC SLEEP PHYSIOLOGY • Sleep is a complex series of events • Balanced by neurotransmitters in the brain and brainstem • Affected by light and daily natural rhythms SLEEP DISORDERED BREATHING • Patients are tired all the time – Key symptom-daytime sleepiness • Patients are constantly awakened by pharyngeal collapse • Prevalence and severity increase with age and weight DEFINITIONS • A sleep-related breathing disorder – A complete stop in airflow despite continuing efforts to breathe • Decrease in airflow is a HYPOPNEA • Stopping of airflow is an APNEA – This decrease or blockage needs to last 10 seconds or more during sleep-REM • Measurement of Oxygen Saturation DEFINITIONS • Upper Airway Resistance Syndrome (UARS)- frequent arousals in response to increased respiratory effort as a result of upper airway narrowing, without overt apnea or hypopnea. • Apnea/Hypopnea Index (AHI)-the number of these obstructive or partially obstructive events per hour (aka Respiratory Distress Index-RDI)- normal is considered less than 10 • Oxygen Saturation-(SaO2) The level of O in the 2 arterial blood (pulse oximetry) WHO GETS OSAS? • 12 million Americans have OSA • Only about 2 million have been diagnosed – OSA with daytime sleepiness=OSA syndrome • 4% of men and 2% of women – OSA without daytime sleepiness • 24% of men and 9% of women • 38% of all hypertensive patients • 50% of obese men; 60-70% of diabetics – 2% of children: Ages 2-8 most commonly associated with large ??? HOW BIG A PROBLEM IS OSA? • OSA May afflict up to 17% of Americans – 24% men; 9% women • Young, et al, The Occurrence of Sleep Disordered Breathing among Middle-aged Adults. New England Journal of Medicine., 1993 • Patients with OSA are at a greater risk for hypertension, heart attack, stroke, diabetes and depression • Fletcher E. The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. American J of Med, 1995 • Hung J, et al. Association of sleep apnea with myocardial infarction in men. Lancet 1990. • Patients with OSA are involved in traffic accidents 2-3 times more often than the general population • Young, et al. Sleep disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997;220:608-13. • Patient with OSA are at an increased risk for injury in the workplace • Lojander J et al. Cognitive function and treatment of OSA syndrome. J Sleep Res. 1999;8:71-6 PREVALENCE • OSA with or without daytime sleepiness – 24% of men and 9% of women – 38 % of hypertensive patients – 50% of Obese men (BMI Scale) • 2% of children: Ages 2-8 – Pre-maturity increase OSA 3-5x – Generally associated with Large ??? IDENTIFYING PATIENTS AT RISK • Dentist is an important entry point for identification and treatment of OSA • Sleep and Breathing 2007 • Visits to the dentist in a 12 month period – 65% of Adults 18-65 – 58% of Adults > 65 • JADA Jan 2010 • Not going to their medical providers • Similar to hypertension in the 70’s and 80’s