Introduction to OSA and Dental Sleep Medicine by Dr. Stephanie Dennison, Dr. Larry Cohen & Dr. William Jacobson

This course will provide an effective protocol for general practitioners to screen patients for OSA and refer those at risk. The screening protocol will consist of three steps: medical history intake, clinical examination and sleep history. A discussion on when and how to refer at-risk patients for OSA will also be included. • Screening Step 1: During the medical history intake, it is important to consider the systemic conditions associated with OSA. Many common cardiovascular, metabolic and neurologic diseases are comorbid with OSA. Additional systemic factors, such as male sex, advanced age, drug and alcohol use, and a family history of OSA, should also be taken into account. • Screening Step 2: During the extraoral and intraoral examination, it is essential to recognize hard and soft tissue anatomy that predisposes a patient to airway collapse. Examples include retrognathia, a narrow and high-arched palate, mandibular tori, enlarged palatine tonsils, and macroglossia. It is also crucial to be aware of non-carious tooth structure loss associated with OSA, such as attrition and acid erosion. • Screening step 3: If, after the routine medical history intake and clinical examination, you have identified risk factors for OSA, it is important to consult with your patient about their sleep. A brief sleep history should be obtained. Wake and sleep symptoms of OSA should be evaluated. Validated OSA questionnaires, such as the STOP-BANG or Epworth Sleepiness Scale, can also be easily administered. If a patient displays risk factors for OSA and their sleep history raises concerns, they should be counseled and referred to their primary care provider (PCP) for further evaluation.