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AADSM Mastery Review > ABDSM Board Review (from Quizlet) > Flashcards

ABDSM Board Review (from Quizlet) Flashcards

1
Q

Which of the following statements is true regarding a modified mallampati classification of the oral pharynx?

A. Mallampati II allows visualization of only the hard palate
B. Malampati III allows visualization of only the hard palate
C. Malampati classifications are taken with the patient sedated and reclined
D. Mallampati classifications of IV have greater odds ratio than Mallampati classifications of I for severe OSA

A

D. Mallampati classifications of IV have greater odds ratio than Mallampati classifications of I for severe OSA

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2
Q

What 8 item questionnaire was developed to perioperatively screen for risk of OSA?

A. ESS
B. STOP-BANG
C. MSLT
D. Berlin

A

B. STOP-BANG

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3
Q

In the pathophysiology of sleep apnea, airway patency and stability is promoted by which factor?

A. Increased lung volume
B. Shorter mandible
C. Increased parapharyngeal fat deposition
D. Negative inspiratory pressure
E. Reduced pharyngeal muscle dilator activity

A

A. Increased lung volume

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4
Q

Oral appliance therapy commonly provides successful sole therapy for which of the following sleep-related breathing disorders?

A. Primary central sleep apnea
B. Cheyne-Stoke periodic breathing
C. Obesity hypoventilation
D. Overlap syndrome (OSA and COPD)
E. None of the above
A

E. None of the above

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5
Q

Which of the following is true about OSA and HTN?

A. Ambulatory BP is increased in OSA patients primarily due to increased salt intake associated with elevated ghrelin levels
B. Ambulatory BP normally increases in the early AM before awakening - this increase is blunted in OSA
C. Untreated OSA is associated with a similar risk of HTN at all severity levels
D. The risk of HTN in untreated OSA is due to intermittent hypoxia, sympathetic overactivation, inflammation, and other complex factors

A

D. The risk of HTN in untreated OSA is due to intermittent hypoxia, sympathetic overactivation, inflammation, and other complex factors

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6
Q

Across a general population, what is the most common sleep disorder?

A. RLS
B. Narcolepsy
C. Delayed sleep phase syndrome
D. Insomnia
E. Obstructive sleep apnea
A

D. Insomnia

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7
Q

Measurement has shown that patients with sleep apnea have smaller upper airways than those without sleep apnea but manage to keep an open airway during wakefulness by:

A. Mouth Breathing
B. Increased muscle tone on inspiration
C. Increased blood flow to the soft tissue
D. Frequent bruxing

A

B. Increased muscle tone on inspiration

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8
Q

Key features of sleep apnea as recorded during an in-lab sleep study include marked reduction or absence of air flow, arousals from sleep, slowing of heart rate and:

A. Choking or gasping for air
B. Oxygen desaturation
C. Flattening of the nasal pressure signal
D. Flailing of the arms and legs
E. Sawtooth waves in the EEG
A

B. Oxygen Desaturation

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9
Q

Who publishes the CPT codebook?

A. The Centers for Medicare and Medicaid Services
B. The American Medical Association
C. The Office of the Inspector General
D. The Durable Medical Equipment Service
E. The American Academy of Sleep Medicine

A

B. The American Medical Association

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10
Q

A 48 year old man is treated with OAT for his moderate OSA. On repeat sleep testing, his apnea-hypopnea index (AHI) has decreased to 3 events per hour, and he reports resolution of snoring and daytime sleepiness. What is the most reasonable dental-medical sleep medicine follow up regimen for this patient?

A. As needed
B. Every 6 months for the first year, then annually
C. Monthly for the first 6 months, then every 6 months
D. Every other year

A

B. Every 6 months for the first year, then annually

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11
Q

Which of the following would exclude oral appliance therapy as a first treatment trial for OSA?

A. Xerostomia
B. Edentulism
C. Micrognathia
D. Steep mandibular plane angle

A

B. Edentulism

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12
Q

Reviewing your patient’s diagnostic polysomnogram, you note more than a 50% epoch consists of alpha waves. According to the current PSG scoring guidelines, the patient is in which stage of sleep?

A. Stage I NREM
B. Stage II NREM
C. Stage III NREM
D. Stage REM

A

A. Stage I NREM

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13
Q

A patient presents for an evaluation to determine their candidacy for an oral appliance to treat their mild OSA. During your examination, you note the presence of TMD. This might include the following:

A. Pain in the TMJ
B. Pain in the muscles of mastication
C. Anomalies in mandibular movement
D. All of the above

A

D. All of the above

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14
Q

The qualified dentist designation (QDD) came about in response to the 2015 practice guidelines paper recommending that physicians refer patients to dentists “qualified” to treat sleep related breathing disorders. This was based upon recognition of which of the following?

A. Older dentists have more experience than younger dentists
B. All dentists have the skills they need to deliver knowledgeable care
C. Oral appliance efficacy data collected in studies is obtained by dentist with extensive clinical experience
D. Training in dental schools on oral appliance therapy has become common place

A

C. Oral appliance efficacy data collected in studies is obtained by dentist with extensive clinical experience

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15
Q

The 2015 Practice Guidelines created through cooperative effort of the AASM and AADSM suggest a physician should seek collaboration with a qualified dentist, described as someone who has at least:

A. Board certification
B. Facility accreditation
C. Completion of a 1 yr residency in dental sleep medicine
D. Additional training or experience in dental sleep medicine

A

D. Additional training or experience in dental sleep medicine

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16
Q

An understanding of loop gain is important to the clinical practice of dental sleep medicine because:

A. It excludes the possibility of cheyne stokes breathing in patients with severe OSA
B. It is the basis of the Mallampati classification system
C. It defines the number of sequential obstructive apneas in an epoch
D. It contributes to the multifactorial nature of sleep related breathing disorders

A

D. It contributes to the multifactorial nature of sleep related breathing disorders

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17
Q

With regards to biomechanical properties of the upper airway, which statement is true?

A. Sleep apnea patients paralyzed during general anesthesia (neural drive removed) demonstrated airway compliance similar to healthy subjects
B. Sleep apnea patients had more negative closing pressures
C. Sleep apnea patients demonstrate a more positive Pcrit
D. There is no correlation between collapsibility when awake and collapsibility when asleep

A

C. Sleep apnea patients demonstrate a more positive Pcrit

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18
Q

Tagged MRI recently showed 3 patterns of tissue formation during mandibular advancement. Which of these was NOT observed?

A. The whole tongue moved forward “en bloc”
B. Only the superior posterior portion of the tongue moved forward
C. The posterior tongue did not move, but the whole tongue elongated
D. Only the inferior posterior portion of the tongue moved forward

A

B. Only the superior posterior portion of the tongue moved forward

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19
Q

In Van Heasendonck’s 2015 systematic review of oral appliance health benefits, mean disease alleviation was calculated using the following:

A. An embedded microsensor
B. A highly compliant patient population
C. Patient’s diaries of hours of nightly device use
D. Patient’s attestations to hours of nightly device use

A

A. An embedded microsensor

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20
Q

Caffeine promotes wakefulness by suppressing or blocking:

A. Thyroid stimulating hormone
B. Growth hormone
C. Orexin
D. Adenosine

A

D. Adenosine

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21
Q

A study design where one or more population samples are followed prospectively to determine which participant’s exposure characteristics (risk factors) are associated with a disease or outcome is called a:

A. Randomized control trial
B. Non-randomized control trial
C. Cohort study
D. Case control study

A

C. Cohort study

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22
Q

In an experiment where participants are randomly assigned, one group receives the drug or procedure, a placebo group’s treatment is disguised to resemble the drug or procedure being investigated and a control group receives nothing. Members of each group are prevented from knowing whether they are receiving active therapy. This would be called a:

A. Randomized control trial
B. Cohort study
C. Randomized case report
D. Blinded triple trial

A

A. Randomized control trial

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23
Q

The masseter muscle originates at:

A. The temporal fossa
B. The zygomatic arch
C. The mylohyoid ridge
D. The coronoid process

A

B. The zygomatic arch

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24
Q

In Sheats et. al., a morning occlusal guide is a common side effect management modality. Which of the following is CORRECT?

A. A MOG encompasses many custom made appliances and pre-fabricated devices used in an effort to reposition the mandible into its habitual pre-treatment position
B. A MOG has a very specific design as established by the AADSM consensus committee on side effects
C. A morning occlusal guide was shown to stretch the lateral pterygoid muscle to full functional length with EMG studies
D. Use of an MOG assures the patient that there will be no bite changes as a result of use of an oral appliance

A

A. A MOG encompasses many custom made appliances and pre-fabricated devices used in an effort to reposition the mandible into its habitual pre-treatment position

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25
Q

All of the following exacerbate sleep disordered breathing, EXCEPT:

A. Use of stimulants within 1 hr of bedtime
B. Consumption of a heavy meal within 1 hr of bedtime
C. Use of melatonin within 1 hr of sleep onset
D. Use of alcohol, especially as a means to induce sleep

A

C. Use of melatonin within 1 hr of sleep onset

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26
Q

A patient presents to consult with you regarding oral appliance therapy for their moderate OSA. They report intermittent “jaw pain” for the past 6 weeks. You should explain that:

A. It is best to postpone treatment until the pain has resolved
B. An oral appliance is contraindicated for a patient that has active TMD
C. A comprehensive oral-facial evaluation is necessary to ID the source of their jaw pain before considering or proceeding with oral appliance therapy
D. An oral appliance will improve their jaw pain if the source of the pain is muscular, and not originating from the TMJ

A

C. A comprehensive oral-facial evaluation is necessary to ID the source of their jaw pain before considering or proceeding with oral appliance therapy

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27
Q

The most recent research points to the primary etiology of sleep bruxism as:

A. Nicotine, ethanol, recreational drug or caffeine use
B. Peripheral triggers such as occlusal discrepancies
C. Central factors such as stress and psychosocial influences
D. The result of a combination of environmental, biological, and psycho-social influences

A

D. The result of a combination of environmental, biological, and psycho-social influences

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28
Q

According to Caples, et al, risk of fatal and non-fatal cardiovascular events is significantly increased in patients with:

A. Mild OSA
B. Severe OSA
C. Severe OSA on CPAP therapy
D. Both A and B

A

B. Severe OSA

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29
Q

In sleep, heart rate…

A

Slows 10-15 BPM

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30
Q

In sleep, breathing…

A

slows

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31
Q

In sleep, muscles

A

relax

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32
Q

In sleep, BP

A

Decreases (morning dip)

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33
Q

In sleep, body temperature…

A

Decreases, then begins to rise just before morning wakeup time

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34
Q

Which neurons are sleep promoting?

A
  • Ventrolateral Preoptic System (VLPO)

- Median Preoptic Nuclei (MNPO)

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35
Q

Loss of which neurons promotes profound insomnia and sleep fragmentation?

A

VLPO

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36
Q

What does the flip flop switch refer to?

A

Mutual inhibition of sleep and wake promoting neurons triggered by changes in drive for sleep or circadian altering signal

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37
Q

When do the deepest stages of sleep occur?

A

20 minutes after sleep onset

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38
Q

What is referred to as the circadian pacemaker?

A

SCN (Suprachiasmatic nuclei of anterior hypothalamus)

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39
Q

What does the SCN promote?

A

Wakefulness, and maintains sleep after sleep drive dissipates in the 2nd half of the night

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40
Q

Where is melatonin released?

A

Pineal gland

Regulated by SCN

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41
Q

Is melatonin necessary for sleep?

A

No, but helps synchronize circadian rhythms

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42
Q

What causes sleep drive to buildup throughout the day?

A

Buildup of adenosine

Induces sleep by inhibiting wake promoting neurons

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43
Q

What neurotransmitter does caffeine inhibit?

A

Adenosine

Promotes wakefulness

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44
Q

What are some characteristics of REM?

A
  • Increased brain wave activity
  • Eyes move back and forth rapidly
  • Atonic muscles
  • Dreaming
  • High cholinergic, low adrenergic state
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45
Q

When is REM more prominent?

A

Second half of the night - and episodes lengthen throughout the night

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46
Q

What % REM do premature infants have?

A

80%

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47
Q

What % REM do full term neonates have?

A

50%

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48
Q

What % REM do adults 20-69 have?

A

25%

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49
Q

How much sleep does N1 encompass?

A

5-10%

Very light sleep

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50
Q

How much sleep does N2/N3 encompass?

A

65-70%

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51
Q

What phase of sleep are sleep spindles present in?

A

Mostly N2

Very small amount present in N3

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52
Q

Where do sleep spindles originate?

A

Thalamus

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53
Q

Where do sleep spindles propagate?

A

Cortex

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54
Q

What are sleep spindles associated with?

A

Offline memory processes

**Get increased spindle activity after learning

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55
Q

What waves are associated with N1 sleep?

A

Vertex sharp waves - alpha waves

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56
Q

What sleep study architecture is associated with N2 sleep?

A
  • K complexes

- Sleep spindles

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57
Q

When do REM stages start?

A

80-100 minutes after onset of sleep

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58
Q

How long are the cycles between REM and NREM?

A

90 minutes

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59
Q

What are the main purposes of sleep?

A
  • Enhance memory consolidation
  • Promote alertness
  • Hormone release (ADH, GH, Oxytocin, Prolactin)
  • Clear metabolites from brain
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60
Q

How much does brain energy metabolism decrease by during sleep?

A

25%

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61
Q

What hormones are released during sleep?

A
  • GH
  • ADH
  • Oxytocin
  • Prolactin
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62
Q

What does the glymphatic system do?

A

Flushes out toxins, proteins, metabolic waste from the brain

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63
Q

How is the sleep cycle in a newborn different?

A
  • Enter REM before NREM
  • Shorter sleep cycles (50 min as opposed to 90 min)
  • 50% REM (declines over first 2 yrs to 20-25%)
  • No Slow Wave Sleep (N3)
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64
Q

What phase of sleep does slow wave sleep occur in?

A

N3

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65
Q

How does slow wave sleep change over time?

A
  • Not present at birth
  • Emerges in first 2 years
  • Decreases during adolescence by 40% in preteen years
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66
Q

How is N3 sleep different between men and women?

A

Women have a higher % of N3 sleep than men, and it decreases slower throughout life

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67
Q

Where are central chemoreceptors located?

A

Ventral Medulla on brain

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68
Q

What do central chemoreceptors detect?

A
  • CO2

- H+

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69
Q

Where are peripheral chemoreceptors located?

A

Carotid Body

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70
Q

What are peripheral chemoreceptors sensitive to?

A
  • HYPOXIA

- Also detect changes in CO2, pH, temperature

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71
Q

What mainly controls alveolar ventilation?

A

Arterial CO2

Have a linear relationship of minute ventilation as CO2 increases

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72
Q

How does O2 relate to ventilation drive?

A

Minimum O2 ventilation drive until PO2 <60, then get enhanced ventilation

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73
Q

How does CO2 relate to ventilation drive?

A

Linear relationship - minute ventilation increases as CO2 increases

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74
Q

What is the definition of apnea?

A

Cessation of airflow for 10 seconds or longer

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75
Q

What is the definition of hypopnea?

A

Decrease in airflow lasting for 10+ seconds

30% reduction of airflow

AND

At least a 3% oxygen desaturation OR an arousal (CMS says 4%)

Shallow breathing
Decreased minute ventilation

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76
Q

Why do humans have sleep apnea and others do not?

A

Longer, more collapsible airway. No overlap of epiglottis and soft palate

Allows advanced speech but unprotected airway during sleep

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77
Q

What is the measure of airway patency?

A

Pcrit

Determined by sum of structural and neuromuscular determinants of airway collapsibility

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78
Q

What does more negative Pcrit mean?

A

Airway is open

Pcrit

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79
Q

What are the 2 fundamental sleep induced changes in OSA?

A
  • Changes in passive mechanics of upper airway

- Critical reliance on chemosensitivity for control of respiratory motor output and its stability

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80
Q

Where does the obstruction most often occur in OSA?

A

Soft palate (81%)

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81
Q

Where else can the obstruction occur in OSA?

A
  • Tongue base (46.6%)
  • Hypopharyngeal collapse (38.7%)
  • Multilevel collapse - most common is palate and tongue base
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82
Q

How many adults have mild OSA?

A

1/5

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83
Q

How many adults have moderate-severe OSA?

A

1/15

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84
Q

What are some risk factors for OSA?

A
  • Obesity
  • Male
  • Diabetes
  • HTN
  • Postmenopausal
  • Large neck >16 inches
  • Atrial fibrillation
  • African american, asian, hispanic
  • Frequent nocturia
  • Upper airway anatomic obstruction
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85
Q

What is a normal score on the ESS?

A

<10

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86
Q

What are some diurnal symptoms of OSA?

A
  • Daytime sleepiness
  • Memory and concentration dysfunction
  • GERD
  • Irritability, depression
  • Traffic accidents
  • Waking with a dry mouth, irritated throat
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87
Q

What are some nocturnal symptoms of OSA?

A
  • Heavy, persistent snoring
  • Apnea with limb movement
  • Nocturia
  • Nocturnal sweating
  • Sudden awakening with noisy breathing
  • Accidents related to sleepiness
  • Insomnia
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88
Q

What does AHI consist of?

A

Apneas + Hypopneas / time

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89
Q

What is the difference in AHI and RDI?

A

RERAs are included for RDI

CMS views AHI = RDI because they don’t recognize RERA’s

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90
Q

What is considered mild OSA?

A

5-15 RDI per hour

CMS will cover OSA therapy if comorbidity like:

  • HTN
  • Stroke
  • Sleepiness
  • Ischemic heart disease
  • Insomnia
  • Mood disorders
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91
Q

What is considered moderate OSA?

A

15-30 RDI per hr

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92
Q

What is considered severe OSA?

A

30+ RDI per hr

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93
Q

What is ODI?

A

Oxygen desaturation index

of 3% desaturations per hr

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94
Q

What does a CPAP do?

A
  • Splints airway open
    • pressure decreases fluid leakage into alveoli
    • pressure decreases work of breathing and O2 requirements
  • Improves cardiac function and output by decreasing preload and afterload
  • Increases lung volume
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95
Q

Does CPAP prevent CV disease in patients with CVD + OSA?

A

No - not compared to usual care alone

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96
Q

What is the compliance rate for CPAP?

A

30-70%

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97
Q

Is nasal patency a major contributor to OSA?

A

NO - using nasal dilators doesn’t significantly improve nasal flow or apnea index

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98
Q

What are the 3 patterns of tissue deformation during mandibular advancement?

A
  • Whole tongue moves forward en bloc
  • Whole tongue elongates
  • Inferior tongue moves forward

**POSTERIOR TONGUE DOESN’T MOVE

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99
Q

What are the cardiovascular benefits of oral appliance therapy?

A
  • Reduced BP (34-75%)

- Endotheilal and left ventricular function improves

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100
Q

Does bariatric surgery/weight loss cure OSA?

A

No - most patients will still have moderate residual OSA - still needs treatment

Does reduce AHI though

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101
Q

How are apneas scored? What are the requirements?

A

Decreased flow signal >90% for >10 seconds

BOTH must be met

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102
Q

What is the difference between obstructive and central apnea?

A

Obstructive has continued effort, central has no effort

Mixed = absence of effort initially followed by resumption of effort

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103
Q

What are the requirements for a hypopnea?

A
  • Decreased flow >30% of baseline for >10 seconds
  • A 3% oxygen desaturation from baseline OR an arousal

**CMS requires 4%

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104
Q

When is a hypopnea considered obstructive?

A

If any of the following occur:

  • Snoring
  • Inspiratory flattening
  • Thoracoabdominal paradox
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105
Q

What is a RERA?

A

Breathes >10 seconds by increasing rate or flattening, leading to an arousal when it doesn’t meet criteria for apnea or hypopnea

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106
Q

When MUST you do a PSG over HST?

A
  • Cardiorespiratory disease
  • Neuromuscular weakness
  • Hypoventilation
  • Opiate use
  • Hx of stroke
  • Severe insomnia
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107
Q

What are the 3 primary signals tested with hST?

A
  • Airflow
  • Respiratory effort
  • Oximetry
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108
Q

Do HST’s over or underestimate OSA severity?

A

Overestimate

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109
Q

What do HST’s not measure?

A

Total sleep time, RERA’s

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110
Q

How is sleep monitored with HST?

A

SCOPER

  • Sleep
  • Cardiac measure
  • Oximetry
  • Position
  • Effort
  • Respiration
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111
Q

How does OSA(OAT???) treat SDB?

A
  • Maintains mandible closed
  • Increases anterior and lateral dimensions of oropharynx
  • Increases anterior and lateral dimensions of velopharynx
  • Increases base of tongue muscle tone
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112
Q

What are some observed changes with OAT?

A
  • Increased lower face height
  • Lateral displacement of parapharyngeal fat pads
  • Anterior positioning of base of tongue
  • Increase in total airway volume
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113
Q

What are some craniofacial characteristics that lead to increased risk of OSA?

A
  • Reduced mandibular body length
  • Inferiorly positioned hyoid bone
  • Retroposition of maxilla
  • Airway length
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114
Q

What % of patients use CPAP >4 hrs per night after 6 months?

A

50%

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115
Q

What reduces AHI more, CPAP or OAT?

A

CPAP

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116
Q

Does OAT reduce BP?

A

Data is limited, but in some patient populations, it is as effective as CPAP at reducing BP

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117
Q

What factors are equal between OAT and CPAP?

A
  • Quality of life
  • Effect on BP, endothelial function
  • Cognitive performance
  • Daytime sleepiness
  • Reduction in arousal index
  • Increased oxygen saturation
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118
Q

What are the main side effects of CPAP?

A

Irritated nose and mouth

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119
Q

When might a tongue retaining device be helpful?

A
  • Ortho
  • Edentulous
  • Pts with TMD who can’t tolerate an MAD
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120
Q

What are the requirements of an oral appliance?

A
  • Allows advancements of 1mm or less
  • Protrusive range of 5+mm
  • Can be placed by patient or caregiver
  • Maintains stable relationship to teeth, implants, or edentulous ridge
  • Maintains structural integrity for a minimum of 3 years
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121
Q

How does protrusion alter the architecture of the airway?

A
  • Displaces the suprahyoid and genioglossus muscle
  • Advances and moves the mandible downward - increases tension on palatoglossal and palatopharyngeal muscles of the soft palate to maintain space in velopharynx
  • Hyoid and mandible are held forward preventing backward rotation of mandible and posterior displacement of tongue into airway
  • Lateral walls move laterally along the pterygomandibular raphe
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122
Q

What are the indications for MADs?

A
  • Minimum of 10 sound teeth per jaw
  • <20% tooth height destroyed by bruxism
  • Ability to protrude the jaw 5-8 mm min
  • Minimum maximum opening of 25-40 mm
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123
Q

What are some contraindications for MAD’s?

A
  • Protrusion of mandible <5mm
  • Active severe TMD
  • Painful opening or chewing
  • Painful TMJ noise/locking
  • Insufficient tooth support for the device
  • PDD or tooth mobility
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124
Q

What is the single most important modifiable cause of sleep disordered breathing?

A

Weight gain

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125
Q

What stages of sleep is sleep bruxism most common in?

A

NREM 1 and 2 (mostly 2)

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126
Q

Where in the TMJ does rotation occur?

A

Lower compartment - first 20 mm of opening

Translation occurs in the upper compartment

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127
Q

Describe the articular disc

A
  • Extension of fibrous capsule
  • No innervation or blood supply
  • Biconcave (like a bowtie)
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128
Q

Where does the anterior portion of the articular disc connect?

A

Superior head of lateral pterygoid

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129
Q

Where does the posterior portion of the articular disc connect?

A

Turns into highly innervated retrodiscal tissue

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130
Q

How is the articular disc held to the condyle?

A

Medial and lateral collateral ligaments

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131
Q

What nerve innervates the TMJ?

A

Mandibular division of the trigeminal

  • Auriculotemporal
  • Deep temporal
  • Masseteric
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132
Q

What’s the origin and insertion of the masseter?

A

Origin: Zygomatic arch

Insertion: Angle, Ramus

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133
Q

What nerve innervates the masseter?

A

Masseteric nerve (V3)

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134
Q

What is the action of the masseter?

A

Elevates mandible

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135
Q

What’s the origin and insertion of the temporalis?

A

Origin: Temporal fossa

Insertion: Coronoid process of mandible

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136
Q

What nerve innervates the temporalis?

A

Temporalis nerve

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137
Q

What are the actions of the temporalis?

A

Elevates and retrudes the mandible

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138
Q

What’s does the inferior belly of the lateral pterygoid do?

A

Depresses the mandible

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139
Q

What does the superior portion of the lateral pterygoid do?

A

Maintains articular disc position during rest and movement

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140
Q

What’s the origin and insertion of the medial pterygoid?

A

Origin: Medial surface of lateral pterygoid plate

Insertion: Medial surface of mandible

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141
Q

What does the medial pterygoid do?

A

Protrudes and elevates the mandible

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142
Q

What are the signs/symptoms of synovitis?

A
  • History of trauma
  • Continuous TMJ pain
  • Tender to palpation
  • NORMAL ROM
  • Acute malocclusion on injured side

**PAIN WITH CLENCHING, BUT NOT WHEN CLENCHING ON TONGUE DEPRESSOR

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143
Q

What’s the treatment for synovitis?

A
  • Anti-inflammatories
  • Physical therapy
  • Aqualizer or soft splint
  • Hard splint if necessary
  • Iontophoresis
  • Phonophoresis
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144
Q

What are the characteristics of temporal tendonitis?

A
  • Pain at temporalis insertion
  • Possible joint, ear, cheekbone, molar pain
  • Could feel like a migraine and cause limited opening
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145
Q

What’s the treatment for temporal tendonitis?

A
  • Injection insertion

- Physical therapy

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146
Q

What are the characteristics of a non-reducing disc displacement?

A
  • Maximum opening 26 mm
  • Deflection TO affected side
  • No clicking
  • History of locking
  • History of reducing disc displacement
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147
Q

How do you diagnose a non-reducing disc displacement?

A

MRI with closed and wide open views

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148
Q

What is the difference between deviation and deflection?

A

Deviation: Jaw goes to the side as you open then recenters at maximum opening

Deflection: Jaw opens and stays off to one side at maximum opening

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149
Q

What is normally the reason for pain in the TMJ after OAT?

A

Too much/little protrusion

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150
Q

What is normally the reason for pain in the masseter after OAT?

A

Usually due to too much vertical, lack of posterior support, or uneven posterior support

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151
Q

How does a case control study work?

A

Those with disease get matched with those without disease

Look back in time for an exposure

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152
Q

What is a cohort study?

A

No disease present to start

Each group exposed to different factors - determine which group has more disease over time

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153
Q

What does the P value measure?

A

Statistical significance - NOT clinical significance

So shows there is a difference in effect between two things, but not the number needed to treat or the magnitude of the effect

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154
Q

What P value shows something is due to chance?

A

P > 5%

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155
Q

Which is more effective at managing mild to moderate OSA with a MAD, 50% or 75% protrusion?

A

Either - they are equal

For severe OSA, 75% protrusion is slightly more effective

156
Q

What do you do at the 1 month post-delivery appointment?

A
  • Non diagnostic HST
  • Nocturnal pulse oximetry
  • After protrusive position, send for PSG or diagnostic HST
157
Q

What are some benefits of combination CPAP and MAD therapy?

A
  • Can reduce CPAP pressure
  • Reduced leakage
  • Less cumbersome mask interface (no straps)
  • Improved compliance and efficacy
158
Q

What is the difference between type 1 and type 2 combination therapy?

A

Type 2 is connected, type 1 is not connected

159
Q

How does MAD work on patients with positional OSA?

A

MORE EFFECTIVE

160
Q

Is MAD treatment more effective with patients with a higher BMI or lower BMI?

A

Lower

161
Q

How does nasal obstruction relate to SDB?

A

Associated with mouth breathing which can decrease effectiveness of OAT

Higher airway resistance is associated with a poorer response to OAT and requirement for higher pressures with PAP

162
Q

What is nasal obstruction an independent risk factor for?

A
  • Habitual snoring
  • Non restorative sleep
  • Daytime sleepiness
163
Q

What is increased nasal resistance an independent risk factor for?

A
  • OSA CPAP tolerance

- Oral appliance failure

164
Q

What is orofacial myofunctional therapy?

A

Neuromuscular re-education of the orofacial muscles with exercises

165
Q

What does Orofacial Myofunctional Therapy DO?

A
  • Eliminates oral habits (i.e. nail biting)
  • Improves static and dynamic tongue position
  • Improves lip seal
  • Enhances nasal breathing
  • Promotes proper chewing, swallowing
166
Q

During the narrative history, it is not entirely clear what Larry would describe as his chief complaint. If a dental sleep medicine clinical fails to determine a patient’s chief complaint or complaints:

a. The SOAP note is invalid and cannot be used for insurance submission
b. The DSM provider will not know when to stop advancing the device
c. The DSM provider may not know how to motivate the patient to remain compliant with treatment during the acclimation period
d. The DSM will never make the patient happy

A

c. The DSM provider may not know how to motivate the patient to remain compliant with treatment during the acclimation period

167
Q

In addition to being able to wear his oral appliance comfortably all night and based upon the narrative, what other reasonable goals of treatment should the dentist discuss with Larry and record in the plan?

a. patient is able to sleep with his spouse without disrupting her sleep. Awakens refreshed without feeling a need for napping and all apneas are eliminated without further need for CPAP
b. Patient is able to sleep with his spouse without disrupting her sleep, is able to wear his CPAP in combination with his OA for at least a portion if not all night, awakens more refreshed, and continues to see progress in weight loss
c. Patient is able to sleep with his spouse without disrupting her sleep, is able to sleep through the night, awakens more refreshed, and is able to lose 50 lbs in 3 months
d. Patient continues to sleep separately from his spouse so that if he has persistent snoring or apneas it does not bother her sleep

A

b. Patient is able to sleep with his spouse without disrupting her sleep, is able to wear his CPAP in combination with his OA for at least a portion if not all night, awakens more refreshed, and continues to see progress in weight loss

168
Q

What are the 3 key parts of informed consent that were discussed during the patient consultation?

a. The risks of sleep apnea with no treatment, the risks of treatment with OA, and the alternative therapies to OA
b. The risks of sleep apnea with no treatment, the risks of treatment with OA, and a referral for bariatric surgery
c. The risks of continued CPAP use, the risks of treatment with OA, and the risks of no treatment
d. Informed consent for OAT should only address possible consequences of OA use

A

a. The risks of sleep apnea with no treatment, the risks of treatment with OA, and the alternative therapies to OA

169
Q

Larry reports that he often falls asleep when he is watching TV in the middle of the day and sitting in his recliner. This should be recorded in the following part of his clinical note:

a. Subjective
b. Objective
c. Assessment
d. Plan

A

a. Subjective

170
Q

Larry has not been successful in wearing his prescribed CPAP more than a few hours per night on average. This should be recorded in the following part of his clinical note:

a. Subjective: Review of Systems
b. Objective: HPI
c. Assessment
d. Subjective: HPI

A

d. Subjective: HPI

171
Q

“CPAP intolerant patient with severe OSA is a candidate for trial of OAT with expectation of less than complete disease eradication from OAT alone” would best fit in this category of the SOAP note.

a. Subjective
b. Objective
c. Assessment
d. Plan

A

c. Assessment

172
Q

At the end of your discussion with Larry, you inform him that you will be contacting his sleep physician to report on the goals of therapy for the patient and Larry’s stated desire to move forward with OAT. Another critical purpose for contacting the diagnosing physician is to:

a. Request contact information for a bariatric specialist so Larry can pursue surgery in combination with his trial of OAT
b. Arrange a lunch meeting so you can encourage the physician to start referring all mild and moderate sleep apnea patients for a trial of OAT before any CPAP trial
c. Request a prescription and/or letter of medical necessity for OAT
d. Impress the physician with your knowledge of PSG

A

c. Request a prescription and/or letter of medical necessity for OAT

173
Q

During your sleep interview with Larry, you discover that he is generally able to fall asleep with his CPAP on, but cannot sleep more than 3 hours with it in place. Which of the following is the most likely explanation?

a. The CPAP ramp feature that starts the pressure low when first turned on and slowly increases to therapeutic levels, reaches its maximum at about 3 hours of continual use
b. His melatonin levels increase the longer he sleeps
c. He is more motivated to wear it at the beginning of the night since his wife is also trying to fall asleep
d. He has more sleep drive at the beginning of the night

A

d. He has more sleep drive at the beginning of the night

174
Q

Which of the following is not an objective finding?

a. CPAP intolerance
b. BMI 35
c. 5mm overbite
d. Anterior incisal wear

A

a. CPAP intolerance

175
Q

Which of the following is NOT an assessment?

a. Evidence of bruxism
b. Supine exacerbation of OSA
c. Weight: 270 lbs
d. Acceptable sleep hygiene practices

A

c. Weight: 270 lbs

176
Q

Which of these is NOT an input component to the Circadian System?

A. Social Factors
B. Light
C: Superchiasmatic Nucleus
D. Alcohol

A

C: Superchiasmatic Nucleus

177
Q

Which of the following will most likely contribute to phase delay?

A. Early Morning walk in sunshine
B. Blue screen use after 7PM
C. Morning use of 10,000 lux light box
D. Menopausal hormone changes

A

B. Blue screen use after 7PM

178
Q

Which is true about influences on the sleep-wake cycle?

A. Caffeine promotes wakefulness by blocking Adenosine
B. Zeitgebers inhibit maintenance of a 24 hour cycle
C. Melatonin levels begin to decrease at sleep onset
D. The homeostatic drive decreases throughout the day

A

A. Caffeine promotes wakefulness by blocking Adenosine

179
Q

Which of the following is true about sleep spindles?

A. They signal a movement of memory related data from the hippocampus to the cortex
B. They are most abundant in NREM I
They allow environmental input into the sleeping brain, such as bedroom noise
D. Men have twice as many sleep spindles as women

A

A. They signal a movement of memory related data from the hippocampus to the cortex

**Associated with OFFLINE MEMORY PROCESSES

180
Q

Which PAP failure patient may benefit from combination PAP-MAD Therapy?

A. Pressure setting uncomfortably high
B. Unconscious removal
C. Claustrophobia
D. Mask causing facial sweating

A

A. Pressure setting uncomfortably high

181
Q

What can be said regarding the standard of care for oral appliance titration or calibration procedures?

A. There is no standard titration procedure
B. Dentists or their supervised staff should titrate the devices for patients during clinic visits
C. Titration or calibration should proceed protrusively to the patient’s maximum comfortable position
D. Titration or calibration should be routinely evaluated with home sleep testing

A

A. There is no standard titration procedure

182
Q

Which of the following is true regarding Muller’s maneuver?

A. It is used to distinguish between OSA and CSA
B. After forced expiration, an attempt at inspiration is made with closed nose and mouth
C. After maximum inspiration, an attempt at expiration is made with closed mouth and nose
D. It helps to clear the eustachian tubes during dramatic altitude changes

A

B. After forced expiration, an attempt at inspiration is made with closed nose and mouth

183
Q

Which of the following would be difficult to ID during a nasal examination performed without an endoscope?

A. Deviated septal cartilage
B. Enlarged turbinates
C. Nasal valve collapse
D. Nasal polyps

A

D. Nasal polyps

184
Q

What can be concluded regarding nasal obstruction and OSA?

A. Nasal obstruction is associated with snoring
B. Nasal obstruction is associated with OSA
C. Nasal obstruction is associated with lowered concentration of pulmonary nitric oxide
D. All of the above

A

D. All of the above

185
Q

What can be concluded regarding nasal resistance and treatment of OSA with OAT?

A. Lower nasal resistance is a predictor of improved OAT response
B. Higher nasal resistance is a predictor of improved OAT response
C. Women with higher nasal resistance show improved response to OAT
D. Nasal resistance increases with protrusive positioning of the mandible

A

A. Lower nasal resistance is a predictor of improved OAT response

186
Q

Where is the velo-pharynx?

A. In the nasopharynx above the horizontal position of the soft palate
B. In the oral pharynx behind the vertical portion of the soft palate
C. In the hypopharynx below the epiglottis
D. Between the velum and hard palate

A

B. In the oral pharynx behind the vertical portion of the soft palate

187
Q

During a DISE procedure, the collapse of the velopharynx is described as “concentric”. What is the best conclusion affecting treatment decisions?

A. Patient is a good candidate for hypoglossal nerve stimulation therapy
B. Patient is a good candidate for Oral Appliance Therapy
C. Patient is a good candidate for Pillar’s Procedure
D. Patient is a good candidate for CPAP therapy

A

D. Patient is a good candidate for CPAP therapy

188
Q

Which statement is true regarding the relationship between nasal obstruction and CPAP use?

A. Less than 20% of patients who try CPAP have nasal complaints
B. Nasal surgeries can decrease CPAP pressures
C. Nasal surgeries are not shown to improve CPAP compliance
D. Nasal surgeries increase ESS and AHI

A

B. Nasal surgeries can decrease CPAP pressures

189
Q

What can be said regarding response rates to UTPP surgery based on the level of obstruction?

A. With obstruction at the oropharyngeal level, UPPP improved the apnea index the least
B. With obstruction at the nasal valve, UPPP improved the apnea index the most
C. With the obstruction at the oropharyngeal level, UPPP improved the apnea index the most
D. With obstruction at the hypopharyngeal level, UPPP improved the apnea index 87%

A

C. With the obstruction at the oropharyngeal level, UPPP improved the apnea index the most

190
Q

Which is one of the inclusion criteria for a Hypoglossal nerve stimulation surgery?

A. AHI <15
B. BMI >32
C. Concentric collapse demonstrated with DISE
D. <25% central or mixed apneas

A

D. <25% central or mixed apneas

191
Q

What does the “flip flop switch” describe?

A

Mechanisms in the control of the switch between REM and NREM, as well as Sleep and Wake

192
Q

Where is the circadian clock in mammals?

A

SCN

193
Q

How do we know that the sleep/wake cycle is regulated by the SCN?

A

Because even without environmental time cues, cycle continues on approximately a 24 hr basis

194
Q

How does light get to the SCN?

A

Retinal ganglion cells

195
Q

Where are sleep spindles present?

A

N2 mostly

Also N3

196
Q

Where do sleep spindles originate?

A

Thalamus

197
Q

Where do sleep spindles propogate?

A

Cortex

198
Q

What are some characteristics of REM?

A
  • Diffuse muscle atonia
  • Vulnerable to enemies
  • High cholinergic, low adrenergic state
  • Consolidates emotional memories, reduces their emotional tone
199
Q

What are sleep spindles associated with (what do they do)?

A

Offline memory processes

200
Q

How much sleep does the AASM say adults 18-60 years of age require?

A

7+ hours

201
Q

How much sleep does the NSF say that adults 26-64 should have?

A

7-9 hours

202
Q

What % of the US population sleeps less than 7-8 hours?

A

35-50%

203
Q

What % of the adult US population sleeps less than 6 hours?

A

15%

204
Q

What is one night of sleep deprivation equal to?

A

Legal intoxication

205
Q

What are the effects of sleep loss on the cardiovascular system?

A
  • Increased heart disease
  • Increased BP
  • Increased risk for heart attack, stroke

IF <5 hrs of sleep, have 45% greater risk

206
Q

What are the endocrine effects of sleep loss?

A
  • Increase in stress hormones
  • Affects thyroid, GH
  • Diabetes and impaired glucose tolerance
  • Affects appetite regulating hormone
207
Q

What are the effects of sleep loss on the nervous system?

A
  • Affects balance (more falls)

- Increased tremors, seizures, pain, headaches

208
Q

What are the effects of sleep loss on mental health?

A
  • Decreased neurotransmitters affecting mood (stress, irritability, depression, alcohol use, suicide)
  • Decreased quality of life
209
Q

What are the effects of sleep loss on risk of early death?

A

Increases risk of dying by ANY cause by 15-30%

210
Q

What are the characteristics of insomnia?

A
  • Difficulty initiating or maintaining sleep
  • Waking earlier than desired
  • Difficulty at least 3 nights per week for at least 3 months
  • Daytime impairment due to sleep difficulty
211
Q

What is delayed sleep phase syndrome?

A
  • When a persons sleep is delayed 2+ hours beyond socially acceptable bedtime
  • Typically seen in teenagers
212
Q

What is the most likely cause of narcolepsy?

A

Autoimmune

213
Q

What is the major marker of narcolepsy?

A

REM sleep during 2+ daytime naps

Dysfunctional switching from REM –> wake during sleep

Patients are mentally awake but physically in REM

214
Q

What other syndromes does periodic limb movement occur in?

A
  • Narcolepsy

- OSA

215
Q

What should be tested medically in periodic limb movement disorder?

A
  • Iron/anemia

- Kidney/Liver Function

216
Q

When is PSG appropriate over HST?

A
  • Paroxysmal arousals
  • Sleep disruption related to seizure
  • Parasomnia
  • PLMS narcolepsy
  • Central sleep apnea syndrome
217
Q

What EEG characteristics are common in N1?

A

Vertex sharp waves

218
Q

What EEG characteristics are common in N2?

A

Sleep spindles

K complexes

219
Q

What EEG characteristics are common in N3?

A

Slow wave activity

220
Q

What EEG characteristics are common in REM?

A

Sawtooth waves

221
Q

Can CPAP prevent CV events in patients with moderate to severe OSA + CVD?

A

No, not compared to usual care alone

222
Q

What is the difference between APAP and BPAP?

A

APAP: Automatic - range rather than one single pressure, fluctuates automatically

BPAP: 2 pressures, one for inhalation and lower for exhalation

223
Q

Who may benefit from BPAP?

A

People with lung disorders (COPD) or CHF

224
Q

What is central sleep apnea?

A

Cessastion of respiratory drive resulting in a lack of respiratory movement/effort

The brain doesn’t tell the muscles to breathe

225
Q

What does everyone who has central sleep apnea have periods of?

A

Respiratory alkalosis

226
Q

What is the LAST resort for central sleep apnea treatment after APAP, CPAP, BPAP?

A

ASV Therapy - Adaptive Servo Ventilation Therapy

Adjusts pressure delivery based on detection of apneas

Reduces PS during hyperpnea to increase CO2 levels above apneic threshold

227
Q

What is the minimum required follow up after delivery of a MAD?

A

Phone contact within 7 days to assess adherence and tolerance

228
Q

How is basic respiration controlled?

A

Carotid body and aortic arch and other chemoreceptors at the base of the brain sense levels of O2 and CO2, then send signals via glossopharyngeal and vagus nerves to the brain, which then send signals to the phrenic and intercostal nerves to control respiration

229
Q

What happens to the body’s response to hypoxia and hypercapnea at night?

A

Breathing settles - get a small drop in PO2 and rise in PCO2

Settles even worse during REM

230
Q

How does the genioglossus compare in patients with OSA vs. patients without?

A

Increased genioglossus muscle activity to try to keep the airway open

231
Q

What is the first line therapy for kids with airway issues?

A

Tonsillectomy

232
Q

What is the meuller maneuver?

A

Hold nose with mouth closed and try to suck in

The airway will collapse due to negative pressure in upper airway

233
Q

What is the narrowest part of the upper airway?

A

Nose - 20-50% of airway resistance is here

234
Q

What does poiseuille’s law show with regards to the nose?

A

Small changes in the radius of the airway can create massive changes in airflow

235
Q

How might we know if turbinates are contributing to breathing issues?

A

If the patient can’t tell which side of the nose they are having trouble breathing through

236
Q

How do we determine if the obstruction is at the nasal valve?

A

Cottle maneuver

Pull side of cheek laterally on the side of interest to determine of obstruction is at valve or deeper inside nasal cavity

237
Q

Will people with nasal obstructions respond better or worse to OAT?

A

Women who complained of nasal obstruction were 9 TIMES LESS LIKELY to respond to OAT

238
Q

What is the purpose of a drug induced sleep endoscopy?

A
  • Guide interventions (surgical or oral appliance)
  • Analyze surgical failures
  • Analyze CPAP or OA failures
239
Q

What are the goals of nasal surgery for OSA?

A
  • Improve nasal airway
  • Resolve snoring
  • Improved SDB subjective symptoms
  • Improve CPAP/OA compliance
240
Q

What is a non-surgical way to stabilize the nasal valve?

A

Do nasal medications improve snoring/OSA?

241
Q

Do nasal dilators impact OSA/snoring?

A

Do NOT impact OSA, but may improve snoring

242
Q

Does surgical therapy for nasal obstruction improve sleep disordered breathing?

A

Improves subjective indicators (snoring, sleepiness, quality of life)

Does NOT improve objective indicators

243
Q

What IS the benefit of nasal surgery with OSA?

A

Can facilitate CPAP use if nasal obstruction is the factor limiting compliance

244
Q

Is soft tissue surgery effective in treating patients with OSA?

A

<50% effective

245
Q

What do you remove in the classic UPP?

A
  • Tonsils

- Sometimes remove the uvula

246
Q

Who does UPP work great for?

A
  • Large tonsils

- Small tongues

247
Q

What are the functions of the uvula?

A
  • Sensation
  • Mucous production
  • Speech
  • Swallowing
248
Q

What can happen to speech if we remove a portion of the soft palate?

A

Can become hypernasal

249
Q

Does MMA surgery reduce AHI?

A

Yes

250
Q

How does a tracheotomy affect patients with OSA?

A

Decreases mortality in patients with severe OSA

251
Q

What are some other skeletal surgeries sometimes used to treat patients with OSA?

A
  • MMA
  • Genioglossus advancement
  • Hyoid suspension
  • Transpalatal advancement
  • Tracheotomy
252
Q

What is hypoglossal nerve stimulation?

A

Implantable device goes into right upper chest and reaches out to hypoglossal nerve and intercostal muscles

253
Q

Who is NOT a good candidate for hypoglossal nerve stimulation?

A

Patients with concentric collapse

So need to undergo DISE before deciding to proceed with hypoglossal nerve stimulation

254
Q

How does weight loss affect severity of apnea?

A

10% weight reduction leads to 25% reduction in severity of apnea

255
Q

What are the 4 key phenotypes that contribute to OSA?

A
  • Anatomically narrow/collapsible

Nonanatomic:

  • Ineffective upper airway muscle dilator
  • Unstable respiratory control (high loop gain)
  • Low arousal threshold
256
Q

What % of apneics are of the anatomically narrow/collapsible phenotype?

A

30%

257
Q

What % of apneics have collapsibility similar to non-apneics?

A

19%

258
Q

What % of apneics have the non-anatomic phenotype?

A

70%

259
Q

What % of apneics have ineffective upper airway dilator muscle function?

A

36%

260
Q

What can overcome high Pcrit?

A

Robust muscle responsiveness

261
Q

Do nasal medications improve snoring/OSA?

A

No

262
Q

Can individuals with high Pcrit and poor muscle control benefit from OAT alone?

A

No

263
Q

What % of apneics exhibit the high loop gain phenotype?

A

36%

264
Q

Is cortical arousal necessary to restore airflow?

A

No

20% of adult events resolve without arousal

50% of children events

90% of infant events

265
Q

What is the PALM scale?

A

Used to encourage targeted treatment of OSA

P: Pcrit (high)
A: Arousal (low)
L: Loop Gain (high)
M: Muscle response - ineffective (low)

266
Q

How does the airway length affect collapsibility?

A

Longer airway = increased collapsibility

Lower hyoid = increased collapsibility

267
Q

Is tongue stiffness higher or lower in apneics?

A

Lower

268
Q

What is the difference between thermal acrylic and thermacryl?

A

Thermal acrylic is rigid at room temperature, flexible at mouth temperature. May lose retention with time

Thermacryl is rigid at mouth temp, fluid at 160 degrees

269
Q

What % of patients improve after UPPP?

A

40%

270
Q

What % of patients get worse after UPPP, and why?

A

10%

Due to late circumferential scarring

271
Q

How does weight gain affect AHI?

A

10% weight gain leads to a 32% increase in AHI

10% weight loss leads to a 26% decrease in AHI

272
Q

How does overbite/overjet change with OAT?

A

Both decrease

273
Q

How do the maxillary incisors change with OAT?

A

Flare lingually

274
Q

How do the mandibular incisors change with OAT?

A

Flare labially

275
Q

How do maxillary molars change with OAT?

A

Tip distally

276
Q

How do mandibular molars change with OAT?

A

Tip mesially - can extrude distal cusp and lead to an open bite

277
Q

When should you discontinue oral appliance therapy?

A
  • Not tolerant/unwilling
  • Limitations in ROM due to TMJ
  • Orthodontic changes and pt chooses to stop
  • Significant changes in periodontal health
  • Oral surgery, oral cancer treatment
  • AHI gets worse
  • Pt has unrealistic expectations
  • Uncontrollable gag reflex
  • Physician alters treatment plan due to change in patient’s medical condition
278
Q

Do women have more or less success with OAT than men?

A

MORE, but they are more likely to abandon treatment earlier than men due to side effects

279
Q

How much force does 1mm of mandibular advancement put on teeth?

A

1.18 N

Teeth can move with as little as 0.9 N of force

280
Q

What is the compliance rate with OAT at 5 years?

A

50%

281
Q

Do overjet and overbite continually reduce throughout treatment?

A

Overjet does, overbite changes wane

**The amount of total change in overjet is significantly correlated to initial AHI

282
Q

What are some predictors of negative bite change?

A
  • Frequency
  • Hard splints
  • Smaller pre-treatment overbite and overjet
  • Number of teeth
  • Larger advancement
  • Device design
283
Q

How do the contacts change over time with OAT?

A
  • Decreased posterior occlusal contacts

- Increase in anterior contacts as overjet is reduced

284
Q

When does most tooth movement tend to concentrate?

A

Around the 2 year mark after starting OAT

285
Q

When do most symptoms occur with OAT?

A

Most get better at 3 months

At 6 months, some will have posterior open bites, but by 1 year very few even notice

286
Q

At what level of protrusion do side effects increase?

A

50%

Between 50-75% protrusion there isn’t a lot of reduction in AHI

287
Q

What could be reasons for dry mouth with OAT?

A
  • Medication (diuretics, anticholinergics)
  • Alcohol
  • Obligate mouth breathing
  • Unable to achieve lip seal
288
Q

What are some management options for dry mouth with OAT?

A
  • Xylimelts, Salagen
  • Close anterior opening
  • Reduce vertical to improve lip competency
289
Q

Does most dry mouth with OAT self correct?

A

Yes - give it a few days

290
Q

What are some possible causes of unilateral open bite with OAT?

A
  • Muscular dysfunction (lateral pterygoid on ipsilateral side in spasm)
  • Left side TMJ disc recapture
291
Q

What are some management options with unilateral open bite with OAT?

A
  • Rule out lateral pterygoid spasm
  • Ensure equal advancement
  • Lessen advancement
  • Discontinue appliance use and see if open bite resolves
292
Q
  • Initial OA setting too far advanced
  • Uneven contact of posterior pads
  • Too much advancement at one time (lower increment necessary)
    What are some potential causes of too much pressure on front teeth/Masseter soreness?
A
  • Initial OA setting too far advanced
  • Uneven contact of posterior pads
  • Too much advancement at one time (lower increment necessary)
293
Q

Where does patient normally feel pain if there is too much advancement initially?

A

TMJ, not muscles

294
Q

How does sleep architecture change when sleep time is insufficient?

A

It doesn’t

295
Q

When does dreaming occur?

A

All stages, but most dreams that are remembered occur in REM

296
Q

How does the ratio of NREM to REM change as we get older?

A

Increased NREM, less REM

This is why we get exhausted as we get older - we aren’t getting restorative sleep

297
Q

Do bottle or breast fed newborn babies sleep longer?

A

Bottle

Average is 14 hrs for babies

298
Q

What does a newborn’s sleep wake cycle depend on?

A
  • Hunger

- Satiety

299
Q

What’s common in infant sleep?

A

Arousals - due to the shorter sleep cycles of 15 minutes

300
Q

When in life does circadian rhythm begin to be influenced by melatonin?

A

Toddlers - 1-3 years)

301
Q

How does adolescent sleep change?

A
  • Reduction in slow wave sleep

- Marked decrease in % of REM from birth to adolescence

302
Q

What are the wavelengths like in N1 sleep?

A
  • High Frequency

- Low amplitude

303
Q

What are the wavelengths like in N2 sleep?

A
  • Lower frequency
  • Higher amplitude
  • *High amplitude slow wave spikes
  • *Rhythmic bursts
304
Q

In what stage of sleep is growth hormone released?

A

N3

Release increases as we age

305
Q

When in sleep does sleep bruxism occur?

A

N1 and N2

306
Q

What can cause sleep bruxism?

A
  • Stimulant medications

- SSRI

307
Q

Who exhibits enuresis more often?

A

Boys more than girls

308
Q

What is enuresis associated with?

A

RLS

309
Q

What can melatonin cause?

A

Precocious puberty when you discontinue

310
Q

Who experiences delayed sleep wake phase disorder more often?

A

Males > Females

311
Q

Who suffers from insomnia more often, girls or boys?

A

Girls

312
Q

How much more likely are preterm babies to have OSA?

A

3-5X

313
Q

What are some risk factors for upper airway obstruction?

A
  • Forward head posture
  • Retrognathic mandible
  • Increased lower anterior face height
  • Inferior portion of the hyoid bone
314
Q

How does OSA affect the inflammatory response?

A

Children with OSA have increased inflammatory cell proliferation

315
Q

What are the greatest cardiovascular sequelae after OSA?

A

What is the secondary cardiovascular sequelae after OSA?

316
Q

Does cephalometry provide any predictive value for apnea diagnosed by PSG in a child?

A

No

Neither does CBCT because no standardized tongue position or threshold for airway volume

317
Q

Nocturnal oximetry at is overestimating AHI at what levels?

A

Low levels

318
Q

How do the definitions of AHI change in children v. adults?

A
  • Apnea: Pause in respiration for 2 breathes v. 10 seconds
  • Hypopnea: Reduction of airflow by 30% for 2 respiratory cycles, accompanied by reduction of O¬2 saturation by 3% or an arousal
  • AHI: Includes both obstructive and central events
  • Obstructive Sleep Related Hypoventilation: >25% of total sleep time spent with PCO2 above 50 mm Hg
  • Arousal: Shift in EEG for at least 3 seconds
  • Periodic Breathing: 3+ episodes of central apnea lasting more than 3 seconds separated by at least 20 seconds of normal breathing
319
Q

What are some CPAP skeletal and dental changes in kids?

A

320/386

Play

Shuffle

Options

  • Maxillary retrusion
  • Counterclockwise tipping of the palatal plane
  • Flaring of the maxillary incisors
320
Q

What is the secondary cardiovascular sequelae after OSA?

A

Pulmonary HTN

321
Q

What are some predictors of poor outcomes after tonsillectomy?

A
  • High arched palate
  • Delayed treatment
  • Mallampati scores of III and IV
  • High pre-treatment RDI
  • Smaller mandibles
322
Q

How does myofunctional therapy affect AHI in children v. adults?

A

Reduces it by 50% in adults and 62% in children

323
Q

Does mouth taping affect OSA?

A

No - significant affect on snoring though

324
Q

What can rapid maxillary expansion do?

A
  • Reduce nasal obstruction
  • Raise tongue posture
  • Enlarges pharyngeal airway
  • Normalizes hyoid bone position
325
Q

What are you predisposed to if you have habitual snoring + insomnia?

A

Gestational HTN

326
Q

What are you predisposed to if you have habitual snoring OR insomnia

A

Babies being born large for gestational age

327
Q

Which of the following statements is TRUE regarding “arousal threshold”?

A. A person with high arousal threshold is easily awakened from sleep
B. Therapeutic strategies to raise arousal threshold could benefit OSA patients who arouse easily from respiratory loads
C. Therapeutic strategies to lower arousal threshold could benefit OSA patients who arouse easily from respiratory loads
D. Regardless of a patient’s arousal threshold, arousal is necessary for airway reopening after an apnea event

A

B. Therapeutic strategies to raise arousal threshold could benefit OSA patients who arouse easily from respiratory loads

328
Q

Which of the following statements is TRUE regarding lung volume?

A. During sleep, upper airway resistance increases as lung volume is reduced
B. Reduced lung volume results in an increase in caudal traction
C. Increased lung volume results in a more collapsible airway
D. There is no interaction between lung volume and pharyngeal patency in non OSA patients

A

A. During sleep, upper airway resistance increases as lung volume is reduced

329
Q

Which of the following factors would contribute to the likelihood of a patient having OSA?

A. Reduced ventilatory response during an apneic arousal (low loop gain)
B. Increased upper airway dilator muscle responsiveness
C. Increased arousal threshold
D. Increased upper airway surface tension

A

D. Increased upper airway surface tension

330
Q

The underlying pathophysiology of OSA is multifactorial and varies considerably between individuals. Which of the following would be a reasonable targeted therapy?

A. Sedatives for individuals with low arousal thresholds
B. Supplemental oxygen for individuals with low loop gain
C. Sedatives for individuals with high arousal thresholds
D. Supplemental oxygen for individuals with stable ventilatory control

A

A. Sedatives for individuals with low arousal thresholds

331
Q

A new patient presents with a class III anterior bite that she believes was caused by use of an oral appliance for her moderately severe OSA. She explains that she is CPAP intolerant. You should immediately:

A. Refer the patient to an orthodontist
B. Advise the patient to discontinue her use of OAT
C. Ask the name of her treating DSM provider so you can make a complaint to the state dental association
D. Gather subjective and objective data until you have enough information to consider an assessment and plan

A

D. Gather subjective and objective data until you have enough information to consider an assessment and plan

332
Q

A patient that you are treating for OSA with OAT presents to your office complaining that her upper and lower back teeth no longer touch when she tries to bite them together. She reports that she can only feel her front teeth touching. After examination, you conclude that this is related to contracture of her lateral pterygoid muscles bilaterally with resultant forward posturing of the mandible. Which of the following will best determine how successful you’ll be in helping her re-establishment of her original occlusion?

A. Degree of original overbite
B. Length of time her muscles have been in contracture
C. Degree of original overjet
D. Class of dental occlusion at the start of treatment

A

B. Length of time her muscles have been in contracture

333
Q

In response to the Epworth Sleepiness Scale, your patient reports they have a very high chance of dozing when laying down to rest in the afternoon when circumstances permit, but no other circumstance when they would doze. Out of a possible 24, your patient’s score would be:

A. 1
B. 2
C. 3
D. 4

A

C. 3

334
Q

During a clinical examination, you note that your patient has missing 3rd molars and short clinical crowns #18, #19, #30, and #31. These teeth are conically shaped and present a retention concern. When you consider the propulsion mechanism of your device, you may want to AVOID selecting:

A. Attached: Bilateral Compression
B: Attached: Anterior Traction
C: Attached: Bilateral Traction
D: Unattached: Bilateral Interlocking

A

C: Attached: Bilateral Traction

335
Q

Accreditation of a facility represents that the DSM services provided exemplify all of the following except:

A. Proficiency
D. Productivity
C. Professionalism
D. Proper protocol

A

D. Productivity

336
Q

Which of the following is NOT part of AADSM standard protocol for long term OAT care:

A. Evaluation for dental side effects
B. Recording vitals
C. Assessment of subjective symptoms
D. Assessment with objective home sleep testing

A

D. Assessment with objective home sleep testing

337
Q

Common dental side effects with long term use of an oral appliance include:

A. Change in occlusal contacts
B. Mesial tipping of maxillary and mandibular molars
C. Increase in overbite and overjet
D. Generalized tooth mobility

A

A. Change in occlusal contacts

338
Q

Regarding long term compliance to OAT (5 years), Marklund found that:

A. Overbite decreases continually but overjet changes wane
B. 90% of patients showed compliance at 5 years
C. Overjet decreases continually but overbite changes wane
D. Only 15% of patients abandoned OAT

A

C. Overjet decreases continually but overbite changes wane

339
Q

The relationship between mandibular advancement and the forces created by the MAD as described by Cohen-Levy is:

A. Linearly related
B. Geometrically related
C. Inversely related
D. Arithmetically related

A

A. Linearly related

340
Q

Which of the following cephalometric predictors is most likely to correlate to MAS success:

A. High mandibular plane angle
B. Reduced distance to hyoid bone and mandibular inferior border
C. Longer soft palate
D. Shorter anterior face height

A

B. Reduced distance to hyoid bone and mandibular inferior border

(Retrognathic mandible)

341
Q

The dental explanation for occlusal contact changes while wearing an oral appliance for SRBD includes all of the following except:

A. Second molar tipping resulting in extrusion of the distal cusps causing an anterior open bite
B. Extrusion of the mandibular incisors
C. Palatal tipping of the maxillary incisors
D. Reduction in overjet due to labial tipping of the mandibular incisors

A

B. Extrusion of the mandibular incisors

342
Q

Sleep architecture during the transition from infancy to preschool is characterized by which of the following changes:

A. Increase in REM sleep
B. Decrease in NREM sleep
C. Increase in SWS (slow wave sleep)
D. Circadian rhythm desynchronization

A

C. Increase in SWS (slow wave sleep)

343
Q

During adolescence, which of the following is likely to occur?

A. Circadian phase advancement
B. Increase in REM sleep
C. Reduction in sleep drive
D. Increase in slow wave sleep

A

A. Circadian phase advancement

344
Q

Children will typically demonstrate which of the following:

A. Higher arousal thresholds during N3 sleep
B. Decreased proportion of N3 sleep as compared to an adult
C. Lower arousal thresholds during REM sleep
D. Sleep spindle activity during N3

A

A. Higher arousal thresholds during N3 sleep

345
Q

Primary enuresis in children:

A. Is pathognomonic of OSA
B. More common in girls than boys
C. Most episodes occur early in the sleep cycle
D. Incidence increases with age

A

C. Most episodes occur early in the sleep cycle

346
Q

Different regions of the brain are affected by chronic sleep loss. Which region of the brain is most likely to be affected by sleep loss resulting in risk taking by the adolescent?

A. Brainstem
B. Prefrontal cortex
C. Amygdala
D. Striatum

A

D. Striatum

347
Q

The scammon curve can best be used to explain how:

A. Class II malocclusions are associated with OAT
B. The child’s airway is anatomically at risk for OSA
C. The hyoid bone moves inferior during growth
D. The palatal shelves respond to RME

A

B. The child’s airway is anatomically at risk for OSA

348
Q

Adenotonsillary hypertrophy (AT) is most often associated with which growth pattern:

A. Bimaxillary protrusion
B. Mandibular prognathism
C. Increased anterior facial height
D. Skeletal brachycephalic

A

C. Increased anterior facial height

349
Q

The BEARS screening tool:

A. Is a screening tool for sleep disordered breathing only useful for children under 5 years of age
B. Asks trigger questions about bedtime problems, ESS, awakenings, REM stage, and snoring
C. Is a screening tool for sleep disordered breathing for children ages 2-18
D. Divides children into 4 age categories

A

C. Is a screening tool for sleep disordered breathing for children ages 2-18

350
Q

In children, use of nocturnal oximetry is problematic because:

A. Children are more likely to desaturate relative to adults
B. Oximetry tends to overestimate AHI at low severity and underestimate AHI at high severity
C. Children show fewer movements in sleep than adults
D. There is excellent sensitivity but poor specificity

A

A. Children are more likely to desaturate relative to adults
B. Oximetry tends to overestimate AHI at low severity and

BOTH ARE CORRECT

351
Q

Compared to adults, children with OSA have:

A. Better preservation of sleep architecture
B. More obstructive apneas
C. More cortical arousals
D. More insomnia complaints

A

A. Better preservation of sleep architecture

352
Q

A predictor of poor outcomes of adenotonsillectomy procedures for children with OSAS is:

A. Early treatment
B. Mallampati scores of I or II
C. Low pretreatment AHI
D. High arched palate

A

D. High arched palate

353
Q

The “Flip-Flop Switch” metaphor of sleep describes:

A. The balance between slow wave sleep and REM stage sleep
B. A long, slow progressions from wakefulness to NREM stage 1 sleep
C. Mutual inhibition between wake promoting neurons and sleep promoting neurons
D. The abrupt suppression of actigraphy activity at the onset of REM sleep
E. A and C

A

E. A and C

354
Q

Which statement is true regarding Melatonin:

A. Melatonin is necessary for sleep
B. Melatonin is released from the Pineal Gland
C. Increased release of Melatonin at end of day is primary factor in sleep drive
D. Caffeine is a non-specific melatonin blocker

A

B. Melatonin is released from the Pineal Gland

355
Q

Which of the following is true regarding REM stage sleep?

A. Premature infants spend less time in REM stage sleep than full term neonates
B. Full term infants spend 80% of total sleep time in REM stage sleep
C. The percentage of REM stage sleep falls during childhood, and plateaus at age 10
D. Normal REM stage sleep as a percentage of total sleep time in adults (ages 20-69) is 25%

A

D. Normal REM stage sleep as a percentage of total sleep time in adults (ages 20-69) is 25%

356
Q

Which of the following is true regarding sleep stages?

A. Sleep spindles and k-complexes appear in NREM Stage 2
B. Vertex sharp waves are abundant in REM Stage
C. PGO and saw-tooth waves are most noted in slow wave sleep
D. High frequency EEG (alpha-beta) is characteristic of NREM Stage 3

A

A. Sleep spindles and k-complexes appear in NREM Stage 2

357
Q

Central Chemoreceptors contribute to respiratory homeostasis and

A. Are located in the midbrain
B. Are sensitive to CO2 and H+
C. Maintain CO2 in a wide physiologic range
D. Detect changes in spinal fluid volume

A

B. Are sensitive to CO2 and H+

358
Q

Which of the following statements is true about the Carotid Body?

A. It is the primary Central Chemoreceptor
B. Hypoxia triggers suppression of minute ventilation
C. Is sensitive primarily to hypoxia
D. Is sensitive primarily to changes in CO2, pH and temperature

A

C. Is sensitive primarily to hypoxia

359
Q

Which of the following statements is true regarding OSA prevalence?

A. After age 50, gender differences become even more pronounced with the ratio of males to females increasing
B. After age 60, BMI becomes an even more important variable
C. OSA is the most common chronic, non-communicable disease in the USA
D. Menopausal hormone changes do not appear to impact OSA risk

A

C. OSA is the most common chronic, non-communicable disease in the USA

360
Q

Which statement is true regarding tools use to screen for Sleep Related Breathing Disorders?

A. The Epworth Sleepiness Score is specific for SRBDs
B. The Berlin questionnaire may be requested by private payers
C. The Berlin questionnaire includes a question on hypertension
D. A high score on the STOP-BANG questionnaire indicates high probability of mild to moderate OSA

A

C. The Berlin questionnaire includes a question on hypertension

361
Q

Which of the following criteria must be met to score a central apnea during PSG according to the AASM Guidelines?

A. At least 90% reduction in flow signal
B. At least 90% reduction in flow signal for at least 10 seconds
C. Evidence of continued effort
D. No evidence of effort
E. B and C
F. B and D
A

F. B and D

362
Q

Which of the following AASM guidelines is recommended by CMS to score a hypopnea during PSG?

A. At least 30% reduction in flow signal for at least 10 seconds
B. An arousal
C. At least a 3% oxygen desaturation from baseline
D. At least a 4% oxygen desaturation from baseline
E. A and B or A and C
F. A and D

A

F. A and D

363
Q

During PSG, AASM guidelines define an obstructive hypopnea when which of the following criteria is met

A. Snoring
B. Inspiratory flattening
C. Thoracoabdominal pardox
D. Any of the above

A

D. Any of the above

364
Q

Which of the following statements is true regarding AASM guidelines for scoring Respiratory Effort Related Arousals, RERAs?

A. CMS recognizes RERAs as hypopneas
B. The clinical definition is precisely defined but the research definition is not agreed upon
C. Breaths with progressively decreasing effort for more than 10 seconds leading to a desaturation and arousal
D. Breaths with increasing rate or flattening for more than 10 seconds leading to an arousal, not meeting criteria for apnea or hypopnea

A

D. Breaths with increasing rate or flattening for more than 10 seconds leading to an arousal, not meeting criteria for apnea or hypopnea

365
Q

A patient that presents with symptoms indicating a risk for moderate to severe OSA and a history of stroke and insomnia. The AASM recommends:

A. The patient submits for HST since it has high sensitivity and specificity for detecting OSA
B. The patient submits for HST since PSG is likely to aggravate the insomnia
C. The patient submits for PSG in conjunction with a sleep evaluation
D. All patients should have PSG if their insurance will cover it

A

C. The patient submits for PSG in conjunction with a sleep evaluation

366
Q

Which of the following is true regarding types of diagnostic studies for identification of sleep related breathing disorders?

A. An in-lab polysomnogram may be either type I or type II
B. A type IV study gathers more data than a type II study
C. A type III study has a minimum of 4 parameters and at least 2 channels of respiration
D. A type II study has a minimum of 6 physiologic variables but no scalp wires

A

C. A type III study has a minimum of 4 parameters and at least 2 channels of respiration

367
Q

The SCOPER classification system

A. Is helpful in determining parameters for in-lab polysomnogram testing
B. Categorizes Sleep, Cardiovascular, Oximetry, Pulse, Effort and Respiratory
C. Classifies and evaluates sleep testing devices for out of center applications
D. Was named for its inventors, Drs Smythe, Carlson, Orace, Peters, Edwards and Rafael

A

C. Classifies and evaluates sleep testing devices for out of center applications

368
Q

When looking at the co-occurrence of OSA and insomnia, which of the following statement are true?

A. Co-occurrence is consistently found to be 65% between groups seeking evaluation for sleep apnea and groups seeking evaluation for insomnia
B. Those with a primary complaint of insomnia tend to be male
C. Those with a primary complaint of OSA tend to be more likely to use alcohol than people with OSA only
D. There is a decreased morbidity and impairment than that which is present with either disease alone

A

B. Those with a primary complaint of insomnia tend to be male

369
Q

Treatment strategies for insomnia in the presence of OSA should make note of the following true statement:

A. Hypnotics, such as benzodiazepines, can have adverse effects on nocturnal respiration, thus exacerbating OSA
B. The newer nonbenzodiazepine agents, such as zolpidem and eszopiclone, appear to increase AHI
C. Cognitive Behavioral Therapy, CBT, is non-pharmacologic and therefore poses no risk
D. CBT is reported to be more effective for insomnia in the presence of OSA than when used for insomnia without comorbidities

A

A. Hypnotics, such as benzodiazepines, can have adverse effects on nocturnal respiration, thus exacerbating OSA

370
Q

Which of the following statements is true about sleep restriction?

A. Approximately 30% of Americans sleep less than 7.5 hours per night
B. Partial sleep deprivation has been studied more extensively than total sleep deprivation
C. Sleep restriction does not impact sleep architecture
D. Significant cognitive dysfunction can occur if sleep is repeatedly restricted to less than 7 hours per night

A

D. Significant cognitive dysfunction can occur if sleep is repeatedly restricted to less than 7 hours per night

371
Q

Which of the following is true regarding the Muller’s maneuver?

a. It is used to distinguish between OSA and CSA
b. After forced expiration, an attempt at inspiration is made with closed mouth and nose
c. After maximum inspiration, an attempt at expiration is made with closed mouth and nose
d. It helps to clear the Eustachian tubes during dramatic altitude changes

A

b. After forced expiration, an attempt at inspiration is made with closed mouth and nose

372
Q

What can be concluded regarding nasal obstruction and OSA?

a. Nasal obstruction is associated with snoring
b. Nasal obstruction is associated with OSA
c. Nasal obstruction is associated with lowered concentration of pulmonary nitric oxide
d. All of the above

A

d. All of the above

373
Q

What can be concluded regarding nasal resistance and treatment of OSA with OAT?

a. Lower nasal resistance is a predictor of improved OAT response
b. Higher nasal resistance is a predictor of improved OAT response
c. Women with higher nasal resistance show improved response to OAT
d. Nasal resistance increases with protrusive positioning of the mandible

A

a. Lower nasal resistance is a predictor of improved OAT response

374
Q

Which of the following is listed from highest to lowest level of evidence?

A. Case reports, Case series, Case control studies, Cohort studies
B. Randomized controlled double-blind studies, Systematic reviews/Meta-analyses, Cohort studies
C. Systematic reviews/Meta-analyses, Cohort studies, Case reports
D. Randomized controlled double-blind studies, Case series, Cohort studies

A

C. Systematic reviews/Meta-analyses, Cohort studies, Case reports

375
Q

A study in which the experiences of individuals with and without a particular disease are analyzed retrospectively to identify putative causative events (exposures) is called a:

A. Systematic Review
B. Meta-analysis
C. Case reports
D. Case-control studies

A

D. Case-control studies

376
Q

In a Randomized controlled trial, if there is incomplete randomization between the intervention group and the control group, this is known as:

A. Selection bias
B. Performance bias
C. Exclusion bias
D. Detection bias

A

A. Selection bias

377
Q

If a test for a disease has a sensitivity of only 40 percent, it means that:

A. It has very few false negative results
B. Fails to find the disease 60 percent of the time
C. It has high specificity
D. Should never be used

A

B. Fails to find the disease 60 percent of the time

378
Q 
What percentage of patients with hypertension suffer from OSA?
A. 25%
B. 30%
C. 40%
D. 50%
A

30-50% ?????

379
Q

Development of a unilateral posterior open bite with use of an oral appliance may be related to:

A. Reduction of a dislocated TMJoint disc on the ipsilateral side
B. Lateral pterygoid spasm on the contralateral side
C. Reduction of a dislocated TMJoint disc on the contralateral side
D. Medial pterygoid spasm on the ipsilateral side

A

A. Reduction of a dislocated TMJoint disc on the ipsilateral side

380
Q

In determining treatment options for TMD symptoms triggered by use of an oral appliance for OSA, the dentist should initially recommend:

A. Discontinued use of the appliance until the adverse symptoms resolve.
B. Continued use of the appliance with watchful waiting and application of palliative exercises and stretching.
C. Use of appropriate medication to mask adverse symptoms in order to continue advancement.
D. Increase in vertical dimension to prevent the patient from clenching on the appliance.

A

B. Continued use of the appliance with watchful waiting and application of palliative exercises and stretching.

381
Q

Patient report of dry mouth in the morning with OAT may be related to all of the following EXCEPT:

A. Obligate mouth breathing
B. Medications
C. Lip competence
D. Insufficient vertical

A

D. Insufficient vertical

382
Q

In contrast to young adults, older sleepers have:

A. More stage III sleep.
B. More REM stage sleep.
C. Later bedtimes.
D. More arousals from sleep.

A

D. More arousals from sleep.

383
Q

Standard AADSM protocol for post delivery follow up of the oral appliance involves:

A. a phone call within two weeks of delivery to the patient
B. an office visit within two weeks of delivery
C. an office visit within one month of delivery
D. a HSAT or pulse oximetry recording acquired within 90 days

A

C. An office visit within one month of delivery

384
Q

Adjunctive strategies to improve therapeutic outcomes of oral appliance therapy for sleep related breathing disorders commonly include all of the following EXCEPT:

A. Allergic rhinitis management
B. Reduction in BMI
C. Hypoglossal nerve stimulation
D. Positional Therapy

A

C. Hypoglossal nerve stimulation

385
Q

When discussing device selection with a patient you should address all of the following EXCEPT?

A. Available space for and position of the protrusion mechanism
B. Missing teeth and compromised teeth
C. AHI and percentage of sleep time below 88% oxygen saturation
D. Patient preference

A

C. AHI and percentage of sleep time below 88% oxygen saturation

386
Q

Who publishes the CPT code book?

A. The Centers for Medicare & Medicaid Services
B. The American Medical Association
C. The Office of the Inspector General
D. The Durable Medical Equipment Service
E. The American Academy of Sleep Medicine

A

B. The American Medical Association

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