Dental Sleep Medicine Insider November DSM Insider | Page 10

KEITH THORNTON, DDS
Figure 1:Assessment and Treatment Algorithm for SRDB
SRBD Patient With or without sleepiness
Overnight home pulse oximetry (>4 hours of sleep), Assess snoring, Assess
observation of sleep
Determine what proportion of recording time
Oxygen saturation has fallen below 90%
<1%
>1%
ESS<7
ESS>8
Any observed
pauses?
Yes
Titrate with Pulse Oximetry
>1%
No
<1%
Treat with oral appliance
Reevaluate every year
with OPO, ESS, Snoring
and sleep observer
questionnaires
OA with Cpap
OA alone
Cpap alone
Trial Oral Appliance
Patient desires
further treatment
Consult with primary
care physician
No
Split night OA-Cpap
Refer to sleep
Surgical consultation
Soft tissue: ENT surgeon
Skeletal abnormality: maxillofacial surgeon
Yes
Yes
Cpap
acceptable to
patient
No