Good morning. This is More Than Teeth. The newsletter that helps dental sleep professionals get 1% better every week.

I cry every time I watch the video at the end of this newsletter…

In today’s issue:

• Independence Day Edition: Our soldiers battle with OSA

• Is there still a place for the Epworth Sleepiness Scale?

• Functionally Diagnosing Breathing Disorders

• Connecting With Your Patients

• Watch The Video At The End..😭

This a 7-minute read today, let’s dive in!👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

1/ Independence Day Edition: Our soldiers battle with OSA💤

We're taking a closer look at how our brave soldiers are finding their own form of liberation—from the grips of obstructive sleep apnea (OSA).

Purpose of the Study 🎯

An ambitious study was conducted among active-duty Army soldiers to:

• Track the incidence of obstructive sleep apnea (OSA) from 2014 to 2019.

• Evaluate the self-reported impacts of OSA and the effectiveness of oral appliance therapy.

• Assess compliance and satisfaction with the oral appliance.

The Methodology 🧪

The Army's health center harnessed data from the Armed Forces Health Surveillance Division and complemented it with self-reported data from soldiers diagnosed with OSA. The analysis honed in on the Army's active component, covering data from 2014 to 2019.

The Findings 👀

Epidemiological insights: Between 2014 and 2019, there were a staggering 87,404 OSA diagnoses among active-duty Army soldiers. The annual incidence ranged from 274.3 to 330.3 cases per 10,000 person-years (p-yrs). Men had a higher incidence rate than women, and soldiers ≥40 years old had the highest incidence of all age groups.

Survey insights: Out of 37,162 surveys sent, 8,740 came back. The majority reported undergoing positive airway pressure (PAP) therapy, but 9% had also used an oral appliance for treatment. Interestingly, soldiers who used the oral appliance reported significant improvements in sleep quality, cognition, alertness, physical activity, fatigue, and daytime sleepiness.

Takeaways 🎁

OSA poses a significant problem among military personel, affecting readiness and overall well-being. While PAP therapy is the conventional treatment, it's costly, needs constant maintenance, and has low compliance. But here's the twist - oral appliance therapy, cheaper, easier to use, and portable, may provide a compelling alternative or complementary treatment.

While being a compelling alternative treatment option, many veterans and active service members are struggling to get this life-saving treatment.

If you don’t already have a military member program for your services, please consider it!

2/ Dental Health Dispatch: The Epworth Sleepiness Scale (ESS)

In today's dispatch, we're diving into the depths of the Epworth Sleepiness Scale (ESS), a key instrument in our toolkit for understanding and assessing Excessive Daytime Sleepiness (EDS).

Deciphering the ESS Cutoff

The ESS score is typically evaluated as a continuous measure, with a common convention using a score of ≥11 to indicate EDS. The crucial takeaway here isn't the absolute number, but the category (normal or high) your patient falls into. Studies have shown that other cutoffs, such as 8 or 12, yield a similar threshold for ESS normalization, suggesting that using ESS as a categorical variable is more important than the specific cutoff.

Test-Retest Variability of ESS

When evaluating the reliability of the Epworth Sleepiness Scale (ESS) - the tool used to measure excessive daytime sleepiness (EDS) - one must consider its 'test-retest variability'. This refers to how consistently the ESS scores remain the same over multiple tests without any interventions in between. Researchers use a measure called Cohen’s kappa to determine this, with scores ranging from 0 (poor agreement) to 1 (excellent agreement).

The ESS has shown promising results, with Cohen's kappa values generally between 0.5 and 0.7 in clinical populations, indicating moderate to substantial consistency in categorizing EDS. This level of agreement holds true even when the cutoff values for ESS scores vary, further validating the ESS as a reliable measure of EDS. Its consistency with retesting is comparable to other commonly used clinical measures, solidifying its standing as a key tool for EDS evaluation.

ESS versus MSLT

In the context of EDS assessments, the ESS can be compared with the Multiple Sleep Latency Test (MSLT). While MSLT is a standard clinical method for diagnosing narcolepsy and idiopathic hypersomnia, it has shown significant variability in retest scenarios. In contrast, the ESS demonstrates more consistent results across retests.

Is the ESS Appropriate for All Populations?

Unfortunatly, ESS's versatility doesn't make it a universal fit in every case. Certain populations, such as women, might not show the same EDS prevalence according to the ESS as men. Therefore, it's essential to consider individual factors and group characteristics when interpreting ESS scores.

Key Takeaways

1. The ESS is an efficient, well-validated, and reliable measure of EDS.

2. The categorical use of ESS scores (normal versus high), rather than the specific cutoff, offers valuable insight.

3. Despite its reliability, ESS might not perform equally for all populations, underscoring the need for a nuanced, individualized interpretation of scores.

Stay informed and apply this knowledge to your practice effectively. Remember, while the ESS is a powerful tool in the fight against sleep disorders, it should be used within the context of comprehensive patient evaluation.

3/Game-changing study on nasal breathing disorders.

It's about to get a little technical but trust us, it's worth it!

Decoding Nasal Breathing Disorders 🔓

A study investigating functional diagnostics (a way to quantify the performance of an organ, like the nose, for example) is reshaping our understanding of nasal breathing disorders. The spotlight here is on posterior active rhinomanometry (PAR), a technique for analyzing how air flows through the nose during forced breathing.

Data, Not Just Hot Air 🔢

This study underscored PAR's ability to differentiate between various nasal disorders, as well as assess structures' contributions to nasal resistance. The million-dollar question – how accurate is it? Here's where the study really delivers: It showed that by combining PAR with computed tomography (CT) data, a more accurate anatomical and physiological interpretation can be achieved.

Here's a data byte that'll get your attention: When survey data from PAR was added to the study, the error rate in detecting nasal breathing disorders plunged from 11% to a measly 5%. And when PAR was integrated into regular patient examinations, the error rate shrunk even more!

Applying the Science 💡

The study suggests these actionable takeaways:

• Use PAR to assess the function of the nasal valve and the structures of the soft palate.

• Consider not just the maximum coefficient of aerodynamic nose drag, but also the values of the pressure drop and air flow rate.

• Leverage CT scans to predict the outcomes of functional rhinosurgical operations.

What's more, these findings have implications beyond just nasal breathing disorders. PAR can also be used to assess nasal damage associated with smell disorders, particularly crucial for those recovering from COVID-19.

In conclusion, as diagnostics evolve, they open up new avenues to delve deeper into various ailments. This knowledge empowers us to adapt our methods and continue to provide superior patient care. Here's to making more precise diagnoses for our patients! 👃👩‍⚕️👨‍⚕️

Help Us Grow

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Business of Sleep

📈Better businesses = more lives saved!

If you're looking to revolutionize the way your patients feel about their treatment…

This is the key.

The Power of Personal Connection💞

Your patient isn't merely a 'human procedure candidate.'

They're an individual who has entrusted you with a part of their over-all health.

Yes, they want you to mitigate their sleep apnea, but they also need a human connection.

Often, they need to feel seen, heard and understood even before they will let you move past their teeth.

The secret recipe? 🤫 

Forge a personal bond that quickly instills comfort and trust.

Balancing Professionalism and Empathy 🗣️

Discovering the sweet spot between professional distance and over-familiarity might feel like walking a tightrope. But the key is asking about their feelings, their perceptions of their health, and how they think you can assist. Then, just listen. Allow them to express themselves without interruption. This simple gesture builds trust and assures patients they're not just another tick off your daily quota.

Practicing Empathy is Key 🗝️

Here's how you can demonstrate empathy in your practice:

1. Acknowledge their concerns: Once they've shared their worries about their sleep apnea, don't immediately jump into diagnostic questions. Pause, and validate their concerns.

2. Non-verbal cues: Empathy is more than words. Non-verbal cues like nodding, using a soothing tone, and not interrupting show that you genuinely care.

3. Adapt to their personality: Tailor your interactions to match their comfort level. A sleep apnea patient might be dealing with a lot of stress and fatigue, so sensitivity is essential.

4. Be their ally: Convey that you're not just a treatment provider, but a partner in their journey towards better sleep and improved health.

Show, Don't Tell 👩‍⚕️👨‍⚕️

Your new sleep apnea patient likely assumes you're qualified to handle their condition. They don't need a rundown of your qualifications. Instead, meet them where they are, and they'll equate your interest in them with your expertise.

Patient-Centric Approach: The Ultimate Game-Changer 🌟

Think of your technical skills as a blockbuster movie with a star (that's you!). But without the compelling story (the patient's concerns and journey), the movie lacks appeal. The success of your practice hinges on your ability to create a powerful bond with your patients. Remember, it's all about them!

Until next time, keep fighting the good fight against sleep apnea and making your patients feel valued! 😁💤

Something Sweet

🍭Stuff so sweet you might get a cavity..

🇺🇸 Happy Independence Day everyone! 🇺🇸

Here is something to wet the eyes before they are blinded by fireworks..

Miscellaneous

😅P.S. … I forgot something

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