Dentists highlight the latest in sleep apnea treatment at Annual Meeting

American Academy of Dental Sleep Medicine
Wednesday, May 24, 2017

DARIEN, IL - More than 1,000 dentists from around the country will gather in Boston for the American Academy of Dental Sleep Medicine (AADSM) 26th Annual Meeting to learn about recent advances in dental sleep medicine and oral appliance therapy. Taking place from June 2-4 at the Boston Marriott Copley Place, the biggest event in dental sleep medicine will showcase top research and provide educational opportunities for attendees.

“With an increase in patients seeking oral appliance therapy for treatment of obstructive sleep apnea, dental sleep medicine is a fast-growing field in the dental community,” said Harold A. Smith, DDS, AADSM president. “The AADSM Annual Meeting is an excellent opportunity for dentists to increase their knowledge of dental sleep medicine and keep up-to-date on the latest progress and research in the field.”

Noteworthy Research Profiled
The AADSM 26th Annual Meeting is an opportunity for dentists and sleep medicine researchers from around the world to present new findings in dental sleep medicine. This year’s highlighted research abstracts include:

• When to Perform Follow-up Polysomnographic Evaluation of Oral Appliance Therapy for Obstructive Sleep Apnea
Study Shows That Questionnaire Can Determine When to Conduct Follow-up Sleep Study
A sleep center asked obstructive sleep apnea patients who were prescribed to receive an oral appliance to complete the STOP (Snoring,
Tiredness during daytime, Observed apnea and blood Pressure) questionnaire after each visit between June 2011 and December 2015. These patients were compared to a control group who did not complete the STOP questionnaire, which consists of four yes/no questions and can identify subjects who are at risk for obstructive sleep apnea if they answer “yes” to two or more questions. At the end of the study, the median STOP score decreased from three “yes” answers to zero in patients treated with oral appliance therapy. Researchers conducted follow up polysomnographic evaluations (PSE) once patients’ STOP scores stopped changing and found that the average apnea-hypopnea index (AHI) improved from 16 to 3 in the STOP group and from 18 to 5 in the control group. However, 64 percent of patients in the STOP group had an AHI of <5 with a >50 percent reduction in baseline AHI, compared to only 41 percent of patients in the control group. Researchers also found that the duration from appliance prescription to a follow-up PSE in the STOP group was longer than that in the control group. These results show that recording of the STOP score can determine when the PSE will demonstrate treatment efficacy, which can reduce unnecessary PSEs that may be costly and inconvenient for the patient.

• Utilizing a Full Digital Clinical Workflow for Oral Appliance Therapy with an Auto-titrating Mandibular Positioner (AMP): A Feasibility Study
Technology Creates Workflow Model That Improves Accuracy and Requires Less Follow-up Time
In this study, participants were divided into two groups. Patients in Group A were administered an oral appliance and a preselected target via a conventional workflow model consisting of impressions and bite registration. Patients in Group B were administered a preselected target and an oral appliance via the conventional model, but after completing an auto-titrating mandibular positioner (AMP) test, they also were selected to receive an oral appliance via a digital workflow model consisting of a digital scan. Patients in both Group A and Group B using the conventional model required in-office appointments for calibrations and/or adjustments. Patients in Group B using the digital model required no in-office visits for dental or occlusal adjustments, and all patients in this group preferred the digital oral appliances in terms of comfort. These results show that, in combination with the AMP test, the digital workflow model for oral appliance therapy can be more accurate, require less follow-up and chair time, and improve patient satisfaction.

• Management of Complex Sleep Apnea with Mandibular Advancement Device: Case Report
Oral Appliance Demonstrates Control of Sleep Apnea Events in PAP-intolerant Patient
The purpose of this study was to show the results of managing complex sleep apnea with oral appliance therapy. Complex sleep apnea, which is also called treatment-emergent central sleep apnea, involves the persistence or emergence of central sleep apnea during administration of positive airway pressure (PAP) therapy for obstructive sleep apnea. A 59 year-old male with severe complex sleep apnea who was intolerant to PAP therapy was fitted with a custom adjustable mandibular advancement device (MAD). Prior to beginning oral appliance therapy, the patient had an apnea-hypopnea index (AHI) of 31.4 per hour with a large amount of central apnea (CA) events (20.2 per hour) and an overall Respiratory Events Index of 38.2 per hour, with the majority of events happening in the supine position. After regularly wearing the MAD, the patient’s obstructive and central sleep apnea were reduced to an AHI of 8.8 and a CA index of 6. The patient reduced his score on the Epworth Sleepiness Scale (ESS) from 13/24 to 4/24, his snoring ceased and he reported better quality sleep. This report shows that a MAD can help improve obstructive and central apnea events in patients who cannot tolerate PAP.

• Combination Therapy for Severe OSA and Relief of TMD Umbrella Symptoms: A Case Report
Mandibular Advancement Device Improves Severe Obstructive Sleep Apnea and TMJ Pain
This case report presents the effects of a mandibular advancement device (MAD) on a patient with severe obstructive sleep apnea and a chronic history of temporomandibular joint (TMJ) pain, headaches and neck pain. A split-night sleep study conducted on a 45 year-old male revealed that he had severe obstructive sleep apnea with an apnea-hypopnea index (AHI) of 71.6 in the first half of the night when receiving no treatment and moderate obstructive sleep apnea with an AHI of 25.4 when using positive airway pressure (PAP) therapy in the second half of the night. However, PAP caused the patient to develop treatment-emergent central sleep apnea and neck pain. An examination also revealed that the patient had chronic symptoms of TMJ including headaches, ear pain and neck pain. To treat the emergent central sleep apnea and neck pain, the patient was fitted with a MAD. After wearing it regularly, he reported improvement in overall quality of sleep and a significant reduction in TMJ symptoms. In a follow-up split-night sleep study, the patient’s obstructive sleep apnea severity was reduced to an AHI of 28.46 while using a MAD in the first half of the night and to 11.57 during the second half of the night while using a combination of MAD and PAP therapy. This case report shows that the use of MAD may be beneficial for patients with pre-existing TMJ symptoms and PAP-emergent central sleep apneas, and a combination of MAD and PAP therapy may help patients with severe cases of obstructive sleep apnea.

The entire program for the AADSM 26th Annual Meeting, which includes education courses, brown bag lunch sessions, lectures and discussion groups, can be found at http://www.aadsm.org/AnnualMeeting.aspx. Dentists interested in applying for AADSM membership should visit the AADSM website at www.aadsm.org.

For the full research abstracts or interviews, please contact Ellyse Orndorff at eorndorff@lcwa.com.

About The American Academy of Dental Sleep Medicine
The American Academy of Dental Sleep Medicine (AADSM) is the only non-profit national professional society dedicated exclusively to the practice of dental sleep medicine. The AADSM provides educational resources for dentists and promotes the use of oral appliance therapy for the treatment of obstructive sleep apnea and sleep-disordered breathing. Established in 1991, the AADSM has more than 3,000 member dentists worldwide. Call the national office at (630) 737-9705 for more information.


Platinum Sponsors
Dental Sleep Solutions
Nierman Practice Management
ProSomnus Sleep Technologies
Space Maintainers Laboratory
Gold Sponsors
Airway Metrics LLC
Dental Prosthetic Services
Myerson/Frantz Design
Oventus Medical
SomnoMed