OSA – Missed or Misdiagnosed?

The CDC estimates that nearly 20% of adults in the US have some form of Sleep Apnea. Additionally, 80-90% of individuals with OSA are undiagnosed. There are many factors that contribute to this high of a percentage.

50% patients with mild-moderate OSA won’t experience any symptoms directly, They may, however, see some long-term effects such as being at a higher risk for chronic health conditions like cardiovascular disease. Many of those with OSA won’t be made aware of their condition until the damage has been done.

 Even if they do have symptoms, they may not realize how problematic they are. OSA symptoms can be as subtle as simply being more tired during the day. This may be easy for some to ignore but it can have detrimental long term effects. 

Individuals also may be concerned about the consequences of reporting their symptoms. Access to sleep testing is low. The idea of attempting to experience a sleep test may be a daunting or even impossible task due to inadequate health coverage and long wait times. It is easy to understand why someone may have concerns about the inconvenience and discomfort of sleep study. They also could be intimidated by the potential of needing to use a CPAP machine. There is a lack of education on what that lifestyle change is truly like.

Sleep dentistry has the ability to reduce or eliminate many of the factors that may prevent OSA patients from receiving treatment.

The Role of Dentists for Diagnosis and Treating OSA

Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Complications of obstructive sleep apnea can include sleepiness during the day and trouble concentrating. cardiovascular problems such as heart attack, high blood pressure, unusual heart rhythms, or stroke.

Dentists have an important role in identifying patients with OSA (Obstructive sleep apnea). As part of routine dental examinations, dentists can recognize a small upper airway and other anatomic risk factors for OSA, and use the opportunity to identify potential patients through use of simple screening questions and/or questionnaires. This can help reduce the problem of under-diagnosis of OSA. The diagnosis of OSA, however, should be reserved for physicians, especially sleep specialists, whose training prepares them to explore the interaction of OSA with other medical diagnoses. Importantly, dentists play a crucial role in evaluating patients with OSA for the suitability of OAT (oral appliance therapy). 

Oral appliances can be worn in the mouth to treat snoring and OSA. These devices are similar to orthodontic retainers or sports mouth guards. Oral Appliance Therapy involves the selection, design, fitting and use of a custom-designed oral appliance worn during sleep. This appliance then attempts to maintain an opened, unobstructed airway in the throat.

Oral appliances work in several ways:

  • Repositioning the lower jaw, tongue, soft palate and uvula
  • Stabilizing the lower jaw and tongue
  • Increasing the muscle tone of the tongue.

Dentists with training in Oral Appliance Therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. Initiation of oral appliance therapy can take from several weeks to several months to complete. The dentist will continue to monitor the treatment and evaluate the response to the OAT treatment, tracking progress.

How Wesper Helps

Enter Wesper, the future of Sleep Health. The Wesper sleep device presents medical-grade, clinically validated data measuring the quality of the wearer’s sleep. With the soft-touch exterior and gentle adhesive, the Wesper sleep patch is extremely easy to administer and comfortable to sleep with. Further, the results of the Wesper tests are available immediately: Every morning after a test, an report is available for the user on their phone, as well as for the dentist/health provider, who is able to access/view the data collected via the Provider Web Portal. 

Wesper can help sleep dentists in two major stages of the OSA diagnosis procedure: 

  1. Firstly, Wesper can be used to help patients screen and understand how their untreated OSA may be impacting their sleep and quality of life. Many patients are often “on the fence” regarding receiving treatments for their sleep apnea. A test with the Wesper device can help encourage these patients to overcome this fence and treat their symptoms by showing them the extent of their undiagnosed OSA. 
  2. Secondly, Wesper can help dentists after the insertion of an oral therapy appliance. During the titration process of the appliance, utilizing Wesper tests over the course of a few weeks can provide sleep dentists with valuable data regarding how patients might be responding to even the slightest of adjustments. This data will then help dentists optimize the effectiveness of the oral appliance and achieve a comfortable equilibrium for their patients.

Thus, Wesper essentially helps sleep dentists offer value-based care by providing them with much-needed data during the process of diagnosing and treating OSA. 

The Wesper Experience

Background:

JC is a healthy 43-year-old male with a normal BMI. He previously underwent an HST after years of suffering from excessive daytime sleepiness, snoring, and occasional breathlessness after waking. He was prescribed the HST Watch-PAT to test for OSA and evaluate snore volume and wakefulness. After he got his result, he followed up with his primary care physician and it was deemed unnecessary for additional testing or treatment, despite JC continuing to be symptomatic for OSA. He also purchased an OTC mandibular advancement device in hopes of treating his symptoms.

JC’s Wesper Journey:

To further evaluate his sleep issues, JC purchased Wesper and took a total of 11 initial tests, 3 with his oral appliance, before booking a consultation to review his results. On review of his data, JC demonstrated mild-moderate inconsistent breathing which fluctuates from night-to-night. His worst nights averaged 12-17 breathing events per hour. His OTC mandibular advancement device reduced his breathing events by an average of 3 events per hour on average, but not significant enough to improve his overall breathing quality. After reviewing his health/sleep history, his symptoms, previous sleep study, Wesper data, and Pulse Ox data, our sleep specialist concluded that a full PSG would likely be determinant for mild OSA. Because OTC MAD was shown to have a mild positive effect on breathing quality, it’s likely that a prescription MAD with titration would improve his breathing quality significantly.

Result:

JC took the results from Wesper and key advice from his consultation to his PCP to review, and his PCP acknowledged there is likely an issue and apologized for not previously taking his concerns seriously. JC was referred to a sleep clinic for a full PSG for further evaluation. While JC waits for his PSG, he continues to test with Wesper while trying various OTC therapies to improve his breathing and sleep quality. With trial and error and continued consultation, JC has reduced his average breathing events per hour from 8 to 4.