HOME SLEEP TESTING & DENTISTRY
AMA resolution H-35.963
states:
“It is the policy of our AMA
that:
1. Ordering and interpreting
objective tests aiming to
establish the diagnosis of
obstructive sleep apnea
(OSA) or primary snoring
constitutes the practice of
medicine;
2. The need for, and
appropriateness of, objective
tests for purposes of
diagnosing OSA or primary
snoring or evaluating
treatment efficacy must
be based on the patient’s
medical history and
examination by a licensed
physician; and
3. Objective tests for
diagnosing OSA and primary
snoring are medical
assessments that must be
ordered and interpreted by a
licensed physician.”
The American Academy of
Sleep Medicine (AASM) has
historically taken the position
that only a Sleep Physician
who is Board Certified has
the knowledge and training
to order a sleep study and
diagnose SRBD. Now the
AMA has joined the AASM in
condemning the actions of
dentists in providing sleep
testing and SRBD diagnosis.
This restriction on sleep
testing (type 3 and type 4
devices), has brought into
question actions by some
dentists who order HSATs.
Readers should be aware
that the legality of dentists
ordering a sleep study for
diagnostic purposes has not
been determined.
If you are screening your
patients and ordering a
HSAT to diagnose whether
your patient has SRBD, you
are at risk of being charged
with practicing outside
your Scope of Practice and
Practicing Medicine without
a license.
Pennsylvania Case: After the
AASM/AMA Policy statements
on HSAT usage was published,
complaints were filed with the
Pennsylvania Dental Board
and the Pennsylvania Medical
Board accusing Dr. X a
Pennsylvania general dentist,
of practicing outside the
scope of his dental license and
practicing medicine without
a license. Dr. X routinely
screened his patients for
SRBDs and dispensed an Ares
HSAT to test his patients.
Each sleep study was scored
and diagnosed by a board-
certified sleep physician
who worked for the testing
company. The physician had a
Pennsylvania medical license.
Dr. X relayed the diagnosis of
Mild OSA to his patient who
then felt compelled to initiate
the respective complaints
with the Pennsylvania Medical
and Dental Boards. The
Boards had been placed on
notice by the AASM/AMA
statement on SRBD, therefore
Dr. X was subjected to a full
investigation of this matter.
The biggest area of concern
for Dr. X was the fact that
practicing medicine without
a license is a criminal act in
Pennsylvania and subject to
all associated remedies.
As the investigation unfolded,
Dr. X was allowed to submit
a brief of the current state of
affairs regarding HSAT testing.
Both Pennsylvania boards
were made well aware of
the turf battle that currently
rages between DSM providers
and Sleep Physicians. Based
on the facts submitted, the
respective boards dropped
the matter. This issue caused
Dr. X to suffer physically,
emotionally and financially
due to his decision to provide
HSAT testing. This matter was
completed and recorded on
June 7, 2018, therefore, this
information is timely.
I am well aware that many
sleep testing companies
are encouraging dentists to
provide the identical care
that was provided by Dr. X in
the above case. I know that
numerous CE providers have
endorsed this protocol to
jump start your DSM practice.
I understand your frustration
with sleep physicians who
don’t respect you as sleep
professionals and will not
refer, however, you must be
aware of the risks associated
with this protocol.