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Sleep Apnea Management for the Dentist

Course Number: 578

Epidemiology of Obstructive Sleep Apnea

OSA is a common sleep disorder gaining increased recognition and attention. OSA is prevalent in both children (1-5%) and adults (10-30%). OSA is more prevalent in men (22%) than women (17%) and the risk of developing OSA increases with advancing age and higher body mass index (BMI).6

There are predisposing risk factors for OSA which include maxillary and/or mandibular hypoplasia, macroglossia, tonsillar hypertrophy, Mallampati classification, a narrow oropharyngeal airway and endocrine disorders such as hypothyroidism. A commonly used screening tool for assessing OSA risk involves use of the STOP-BANG mnemonic.

S – Snoring

T – Tiredness

O – Observed apnea

P – Pressure; blood pressure elevated

B – BMI > 35 kg/m

A – Age > 50 years

N – Neck circumference; > 17” for males or 16” for females

G – Gender, male

  • Snoring: does the patient snore loudly enough to be heard through a closed door or loud enough requiring a bed partner to poke or elbow the patient? Note that snoring is not synonymous with OSA.

  • Tiredness: does the patient report excessive daytime sleepiness? Excessive sleepiness can be measured by a questionnaire tool called the Epworth Sleepiness Scale (ESS). A score of ten or greater may warrant a physician to evaluate for a sleep disorder. A positive ESS is not synonymous with OSA as other sleep disorders may also yield a positive ESS such as primary insomnia.

  • Observed apnea: has a bed partner or roommate witnessed the patient struggling to breathe while sleeping, such as choking or gasping sounds or long periods of time between breaths?

  • Pressure: elevated blood pressure is both a risk factor of, and consequence of OSA.

  • Body Mass Index (BMI): increased weight is a well-known risk factor for OSA. Online or smartphone BMI calculators are available to assess this metric by entering patient height and weight.

  • Age: individuals over the age of 50 years old have higher OSA prevalence than younger people. The soft tissue laxity of aging may contribute to oropharyngeal airway collapsibility.

  • Neck circumference: another correlate with obesity. Neck size of 17” or more in males or 16” or more in females puts a check in this box.

  • Gender: males have higher OSA risk than females.

The Score

OSA - Low Risk : Yes on 0 - 2 questions

OSA - High Risk : Yes on 3 or more questions

A recent study found that patients with a STOP-BANG score of 3 had a 25% probability of a severe OSA. For each additional STOP-BANG point there was another 10% increase in severe OSA probability.7 STOP-BANG does not diagnose patients with OSA, however it should alert the health care professional to make a sleep referral and an eventual sleep study, which is the gold standard in diagnosing the presence of OSA and other sleep disorders.