An Overview of Obstructive Sleep Apnea for Healthcare Providers

Incisal Edge Sleep, Inc. © 2015

What causes Snoring & Sleep Apnea

• As muscles relax during sleep the airway narrows

• As the narrowing increases air pressure increases causing turbulence

• Turbulence causes soft tissue to vibrate and cause snoring sounds

• The airway continues to narrow until breathing is compromised, resulting in Obstructive Sleep Apnea

Snoring, how bad is it?

The National Sleep Foundation estimates:

• 80% of couples with a snoring partner sleep separately

• 90 million Americans have a snoring problem

• 45% of normal adults snore at least occasionally

• Children should not snore

Moving down the sleep continuum

Leading Symptoms of OSA

• Snoring• Excessive daytime sleepiness• Pauses in breathing while

asleep• Depression• Sexual dysfunction• Nocturnal Bruxism• Excessive Nocturnal Urination• Morning Headaches

Apnea Hypopnea Index (AHI)The number of times per hour that a person quits

breathing for a minimum of ten seconds.

Prevalence of OSA in Adults

• 83.8% of males had mild to severe OSA*

• 60.8% of females had mild to severe OSA*

• OSA is more prevalent than Diabetes or Asthma combined

• 90% of patients are undiagnosed

*R Heinzer MD, Svat MD, d Anndries RPSGT, J Tobback RPSGT, M Tafti Phd – Hospital of Lausanne, Lausanne,Switzerland Department of Pulmonary Medicine lancet Respiratory Medicine 2015; 3-310 -18

Why is OSA such a big deal?

Drowsy Driving

24 hours of without sleep = BAC of 0.10

SCREENING WITH A STOPbang

THE STOPbang QUESTIONAIRE

These Yes or No questions can help determine your risk of Obstructive Sleep Apnea:

S: Do you Snore loudly (louder than talking or loud enough to be heard through closed doors?)T: Do you often feel Tired, fatigued or sleepy during the day?O: Has anyone Observed you not breathing during sleep?P: Do you have or have you been treated for High Blood Pressure? B: Is your Body Mass Index (BMI) more than 35 kg/m2?A: Is your Age more than 50 years old?N: Is your Neck circumference greater than 16 inches?G: Is your Gender male? If you answered “YES” to 3-4 questions you have an Intermediate Risk of having Sleep Apnea. If you answered “YES” to 5 or more of these questions you are at HIGH RISK of having Sleep Apnea.

Patient Education Aids

Prescribing Authority

Dentists can prescribe a sleep study in most States.

The interpretation of the study and the diagnosis of OSA must be made by a board certified sleep physician

Dentists can treat a patient with an oral device upon receiving a prescription from a board certified sleep physician.

Why a Sleep Study?

Home Sleep Test Out of Center Sleep Test

Polysomnogram

Testing - Option 1Overnight Sleep Study - PSG

Referred to as an “Attended or Monitored” Sleep study

Patient will spend the night in a sleep lab. The study may include a CPAP titration study. This is known as a split night study.

A PSG Measures:• Blood oxygen levels• Body position• Brain waves (EEG)• Breathing rate• Electrical activity of muscles• Eye movement• Heart rate

Testing - Option 2Out of Center Sleep Test (OCST)

Home Sleep Test (HST)

Used to detect OSA. Limited ability to detect other sleep disorders.

Treatment Options for OSA

AASM Guidelines 2015(American Academy of Sleep Medicine)

Oral Devices are Indicated for use:

• For mild OSA patients who prefer them to CPAP

• For moderate OSA patients who prefer them to CPAP

• For severe OSA patients after they have tried CPAP & failed

• A majority of patients are diagnosed as mild - moderate

CPAP – Continuous Positive Air Pressure

Challenges of using CPAP:

• Claustrophobia• Nasal congestion• Skin Irritation• Noise: Disturbs patient or partner• Position: Must sleep on your back• Embarrassing• Expensive: parts to be replaced• Inconvenient: During traveling,

may require tune-ups & repairs

CPAP Compliance

• There are 125,000 CPAP’s sold every month.

• Multiple studies report CPAP compliance rates at or below 50% at 2 years.

• Most dental offices have CPAP non-compliant patients.

Oral Appliance Therapy

• FDA 510K Cleared

• Comfortable and Convenient

• No Noise, Wires, Tubes, or Plugs

• Discreet: No Embarrassment

• Completely Reversible

• High Patient Acceptance Rate

How oral appliances work?Radiograph of Airway

Regular Bite – Narrow Airway

Protruded Lower Jaw – Appliance in Place

Research & Clinical Trials

• Acceptance 96% Preferred Oral Appliance vs. CPAP• Compliance 88% reported nightly use

• Effectiveness 91% reported improved sleep quality

Practice Financial Opportunity

An average dental practice with 1000 active patients

• 500 patients are women and 10% suffer from OSA

• 500 patients are men and 20% suffer from OSA

• 150 PATIENTS IN THIS PRACTICE HAVE OSA

• The average reimbursement in the U.S. for oral appliance therapy - $2250

• THE UNREALIZED REVENUE FOR UNTREATED OSA IN THIS PRACTICE IS: $337,500

There are sick patients in your Practice. What are you doing to help them?

Contact: Steve Wick, Chief EvangelistIncisal Edge Sleep, Inc.

steve@incisaledgesleep.com