Obstructive Sleep Apnea (OSA)
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Obstructive Sleep Apnea (OSA) - 1

White Paper Using Overnight Pulse Oximetry to Manage Oral Appliance Therapy (OAT) during Treatment for Obstructive Sleep Apnea (OSA) Ronald S. Prehn, ThM, DDS INTRODUCTION It is estimated that obstructive sleep apnea (OSA) affects at least 25 million Americans.1 OSA occurs when a patient’s airway gets blocked during sleep. The benefits of physicians prescribing overnight pulse oximetry testing to pre-screen for OSA are well known.2 In addition, studies supporting the use of overnight pulse oximetry by dental sleep practitioners to confirm their patients’ response to oral appliance therapy (OAT) during treatment for sleep disordered breathing (SDB) are well documented.3 In fact, the American Academy of Dental Sleep Medicine (AADSM) recently recommended in its treatment protocol the use of pulse oximetry home sleep testing to manage mandibular advancement splint (MAS) appliances.4 However, the practice of using a pulse oximeter to manage MAS appliances has only recently entered the mainstream of care. As an alternative to CPAP treatment for OSA treatment, oral appliance therapy (OAT) is often deployed by dental sleep medicine practitioners, working in partnership with referring sleep physicians. With OAT, the patient wears a mandibular advancement splint, which is a mouth-guardlike appliance that positions the lower jaw forward to open the airway continuously through the night. Studies have shown that patients comply better with OAT than with CPAP.7 The American Academy of Sleep Medicine recommends oral sleep appliances as first line treatment options for those with mild and moderate levels of sleep apnea as well as for individuals who are CPAP intolerant.8 About the Author Ronald S. Prehn, ThM, DDS OVERVIEW Sleep disordered breathing (SDB) includes OSA and is part of the scope of temporomandibular disorders (TMD). Not to consider SDB would be ignoring an important factor in the pathology of TMD. Successful treatment of SDB can not only add years to a patient’s life, it can also greatly improve quality of life.5 The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine prescribed by a physician. A CPAP mask is worn over the nose (and sometimes also the mouth) and the mask is connected to a hose that gently pushes air into the throat to keep the airway open during sleep. However, studies have shown that more than half of all patients who use a CPAP machine stop using it within a year due to discomfort.6 Dr. Prehn is the owner of REstore TMJ & Sleep Therapy, a patientcentered medical/dental practice that focuses on the diagnosis and treatment of Headaches/Facial Pain, Temporomandibular Disorders and Sleep Breathing Disorders in The Woodlands, Texas. Dr. Prehn is a member of the American Academy of Orofacial Pain, the American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and the Appliance Therapy Practitioners Association. He is a Board Certified Diplomate of the American Board of Orofacial Pain (a proposed ADA specialty) and the American Board of Dental Sleep Medicine, for which he sits on the board of directo

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Obstructive Sleep Apnea (OSA) - 2

Overnight pulse oximetry monitoring is essential in pre-confirming the effectiveness of OAT for OSA treatment. A pulse oximeter monitors a patient's heart rate and blood oxygen saturation in arterial blood. According to the AADSM and the AASM, overnight pulse oximetry has been shown to be an effective sleep screening tool used to evaluate the response to OAT prior to sending patients back for follow-up polysomnography (PSG) testing at a sleep lab.9 As a specialist in Orofacial Pain and Dental Sleep Medicine, my patients are referred to me for temporomandibular joint syndrome (TMJ),...

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Obstructive Sleep Apnea (OSA) - 3

Using Overnight Pulse Oximetry to Manage Oral Appliance Therapy (OAT) During Treatment for Obstructive Sleep Apnea (OSA) CONCLUSION The need for diagnosing and treating SDB, including OSA, is critical due to the volume of potential patients affected, the associated health risks (diabetes, high blood pressure, heart disease, stroke, depression) and the potential for reduced quality of life (poor concentration, fatigue, increased risk of accidents).10 Diagnosis and treatment of OSA should not have to wait until patients' symptoms are bad enough to drive them into their doctor's office....

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Obstructive Sleep Apnea (OSA) - 4

Using Overnight Pulse Oximetry to Manage Oral Appliance Therapy (OAT) During Treatment for Obstructive Sleep Apnea (OSA) 1. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013 May 1;177(9):1006-14. Dr. Prehn has not received any compensation from Nonin Medical, Inc. for authoring this white paper or endorsing Nonin Medical’s products. 2. Collup NA, Tracy SL, et al. Obstructive Sleep Apnea Devices for Out-Of-Center (OOC) Testing: Technology Evaluation. Journal of Clinical Sleep Medicine, Vol. 7, No. 5, 2011. 3. Rogers, RR....

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