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.

The most common treatment for OSA is continuous positive airway pressure (CPAP) therapy 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 provides air pressure 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.

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-guard-like appliance that positions the lower jaw forward to open the airway continuously through the night. Studies have shown that patients complain better with OAT than with CPAP. 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.

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.

As a specialist in Orofacial Pain and Dental Sleep Medicine, my patients are referred to me for temporomandibular joint syndrome (TMJ), headaches or sleep apnea. After my patients have been diagnosed by a board-certified sleep physician, I use overnight pulse oximetry screening to manage the MAS that I typically prescribe. Specifically for this case study, I used the Nonin Medical WristOx2® wrist-worn pulse oximeter and Nonin's nVISION® data management software to verify the appliance's effectiveness before my patients return to their doctors for a final PSG. I have found that the WristOx2 is the best device for this purpose.

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).

Diagnosis and treatment of OSA should not have to wait until patients' symptoms are bad enough to drive them into their doctor's office. Dentistry has, as part of its treatment structure, a yearly recall of patients. These presences an opportunity for sleep disorder dentists to partner with sleep physicians to improve patient quality of life and lower healthcare costs by working together to diagnose and treat OSA appropriately.

Pulse oximetry sleep tests are useful to dentists for managing MAS appliances but not for diagnosing or confirming resolution of OSA. Only a sleep physician who is board certified in sleep medicine can diagnose or confirm resolution of OSA. MAS is reimbursable, and overnight pulse oximetry sleep tests can be included as part of the cost-of-care delivery.

Oximetry sleep tests are easy and inexpensive for dental sleep practitioners to employ using a pulse oximeter. Training is minimal, and patients appreciate the fact that their oxygen saturation levels are being monitored for verification of MAS effectiveness before they return to their physician for a final PSG. Performing these tests lets the physician know that the dental practitioner is serious about OSA treatment and knowledgeable about how to make treatment
effective.