Intro to Sleep Apnea for healthcare providers
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Transcript of Intro to Sleep Apnea for healthcare providers
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An Overview of Obstructive Sleep Apnea for Healthcare Providers
Incisal Edge Sleep, Inc. © 2015
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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
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Snoring, how bad is it?
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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
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Moving down the sleep continuum
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Leading Symptoms of OSA
• Snoring• Excessive daytime sleepiness• Pauses in breathing while
asleep• Depression• Sexual dysfunction• Nocturnal Bruxism• Excessive Nocturnal Urination• Morning Headaches
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Apnea Hypopnea Index (AHI)The number of times per hour that a person quits
breathing for a minimum of ten seconds.
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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
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Why is OSA such a big deal?
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Drowsy Driving
24 hours of without sleep = BAC of 0.10
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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.
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Patient Education Aids
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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.
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Why a Sleep Study?
Home Sleep Test Out of Center Sleep Test
Polysomnogram
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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
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Testing - Option 2Out of Center Sleep Test (OCST)
Home Sleep Test (HST)
Used to detect OSA. Limited ability to detect other sleep disorders.
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Treatment Options for OSA
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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
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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
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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.
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Oral Appliance Therapy
• FDA 510K Cleared
• Comfortable and Convenient
• No Noise, Wires, Tubes, or Plugs
• Discreet: No Embarrassment
• Completely Reversible
• High Patient Acceptance Rate
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How oral appliances work?Radiograph of Airway
Regular Bite – Narrow Airway
Protruded Lower Jaw – Appliance in Place
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Research & Clinical Trials
• Acceptance 96% Preferred Oral Appliance vs. CPAP• Compliance 88% reported nightly use
• Effectiveness 91% reported improved sleep quality
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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
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There are sick patients in your Practice. What are you doing to help them?
Contact: Steve Wick, Chief EvangelistIncisal Edge Sleep, Inc.