Obstructive Sleep Apnea: A Summary of Clinical Practice Guidelines and the Adherence by Airway Focused Dentists and Orthodontists

Abstract

Introduction: The first aim of this study was to determine the published clinical guidelines regarding the involvement of dental professionals in screening, diagnosis, and treatment of Obstructive Sleep Apnea (OSA). The second aim was to determine whether airway focused dentists and orthodontists were adhering to published guidelines regarding their roles in the screening, diagnosis, and treatment of OSA. Methods: A summary of published guidelines for screening methods and treatment modalities was collated and those endorsed by 50% or more of the sources were considered the common guidelines. A survey was sent to airway focused general dentists (AFD), airway focused orthodontists (AFO) and non-airway focused orthodontists (non-AFO) to enquire about their practices for screening, diagnosis, and treatment of OSA. The results of the survey were then compared to the common clinical guidelines and the three groups of participants were compared to one another. Results: Various professional organizations published guidelines on the methods for screening, diagnosing, and treating patients for OSA. The common guidelines recommended screening patients for OSA and then, referring to a sleep physician for diagnosis and treatment planning, when screening yields positive risk of OSA. Importantly, there were no clinical guidelines for preventing OSA. Some variation existed across the guidelines, including details of screening methods and treatment modalities. There was a response from 48 AFD, 41 AFO, and 78 non-AFO. Airway focused dentists and AFO screened and offered treatment for OSA at a higher frequency than non-AFO. Both AF dentists and orthodontists used radiographs for screening at a higher frequency than non-AFO. Additionally, AFD and AFO offered treatment to prevent and cure OSA. Airway focused dentists referred for tonsillectomy to prevent OSA at a significantly lower frequency that AFO, and AFD utilized maxillomandibular surgery and adenotonsillectomy at a lower frequency than AFO to cure OSA. Approximately half of AFD and AFO occasionally treated patients for OSA in collaboration with a sleep physician. None of the AFD completely adhered to the common guidelines for the steps taken from screening to treating patients for OSA. One AFO and one non-AFO completely adhered to the common guidelines for the above. Conclusions: Clinical guidelines from professional organizations on the management of OSA generally agree on the principles regarding screening, diagnosing, and treating OSA; however, they differ in some methods which may result in variations in the behavior of dentists and orthodontists. Few AFD and AFO consistently adhere to common guidelines for screening, treating, and practicing in collaboration with sleep physicians. Airway focused dentists and AFO provide preventative treatment which is not supported by the common guidelines.