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An Important Guideline: Be on the Lookout for Guidelines

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Current students and recent graduates, you're well aware that a dental education is packed (impacted? There's a little dental humor for ya) with the latest clinical and industry standards. However, those standards change. Dental associations and journals release new guidelines and those guidelines are an important part of your continuing education. To keep updated with new info, be sure to research new guidelines every six to 12 months throughout your career.

The following information on a guideline released recently by the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine is a great example of how new relevant information is always coming down the pike. The guideline provides helpful tools for those treating adult patients with sleep disorders.

Teaming up
In the first official joint guideline from the American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM), oral-appliance therapy is recommended for the treatment of adult patients with obstructive sleep apnea (OSA) who are intolerant of continuous positive airway pressure (CPAP) therapy or who prefer alternate therapy. The new guideline supports increased teamwork between physicians and dentists to achieve optimal treatment of patients with OSA.

Published online in the July 2015 issue of the Journal of Clinical Sleep Medicine, the clinical practice guideline updates the practice parameters that were published by the AASM in 2006. The updated recommendations are based on a systematic review of the relevant scientific literature, which has grown considerably in the past decade. A total of 51 articles met inclusion criteria and were used for data extraction, meta-analysis, and grading.

"This evidence-based guideline reinforces the fact that effective treatment options are available for obstructive sleep apnea, a chronic disease that afflicts at least 25 million adults in the U.S.," AASM president Dr. Nathaniel Watson said. "Although CPAP therapy is still the first-line option for treating OSA, oral-appliance therapy is an effective alternative that is preferred by some patients. Sleep medicine physicians and dentists can promote high-quality, patient-centered care by working together to identify the optimal treatment for each patient who has sleep apnea."

According to the clinical practice guideline, data show that oral-appliance therapy can significantly reduce sleep-disordered breathing, and patient adherence to the treatment may be higher than for CPAP therapy. However, meta-analyses show that CPAP therapy is superior to oral-appliance therapy in reducing sleep-disordered breathing, eliminating arousals from sleep and improving oxygen saturation.

Bringing the patient on board
The guideline notes that the treating board-certified sleep medicine physician should take the patient's preference into consideration when prescribing treatment for sleep apnea.

After a sleep physician prescribes oral-appliance therapy, treatment should be provided by a qualified dentist using a custom, titratable device. An oral appliance helps maintain an open and unobstructed airway during sleep by protruding and stabilizing the mandible.

"Communication and teamwork between sleep physicians and dentists are imperative to providing exceptional patient care," said AADSM president Dr. Kathleen Bennett. "The new guideline supports this collaborative relationship and highlights the important role that dentists can play in the treatment of obstructive sleep apnea."

The guideline also recommends oral-appliance therapy as an effective treatment for primary snoring in adults. However, because snoring is a cardinal symptom of OSA, a diagnosis of primary snoring should be rendered by a sleep physician prior to treatment initiation.

To develop the guideline, the AASM and AADSM commissioned a task force that included three sleep physicians and two dentists with expertise in oral-appliance therapy. The task force members performed an extensive review of the scientific literature to draft recommendations and supporting text. A draft of the guideline was made available for a public comment period, and the revised guideline was approved by the board of directors of the AASM and AADSM.





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