ABDSM
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. Mallampati III allows visualization of only the hard palate
C. Mallampati 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 – answer D. Mallampati classifications of IV have
greater odds ratio than Mallampati classifications of I for severe OSA
What 8 item questionnaire was developed to perioperatively screen for risk of OSA?
A. ESS
B. STOP-BANG
C. MSLT
D. Berlin – answer B. STOP-BANG
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 - answerA. Increased lung volume
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 - answerE. None of the above
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 - answerD. The risk of HTN in
untreated OSA is due to intermittent hypoxia, sympathetic overactivation, inflammation,
and other complex factors
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 - answerD. Insomnia
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 - answerB. Increased muscle tone on inspiration
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 - answerB. Oxygen Desaturation
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 - answerB. The American Medical
Association
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 - answerB. Every 6 months for the first year, then annually
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 - answerB. Edentulism
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 - answerA. Stage I NREM
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 - answerD. All of the above
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 -
answerC. Oral appliance efficacy data collected in studies is obtained by dentist with
extensive clinical experience
, 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 - answerD. Additional
training or experience in dental sleep medicine
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 -
answerD. It contributes to the multifactorial nature of sleep related breathing disorders
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 - answerC. Sleep apnea patients demonstrate a more positive Pcrit
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 - answerB. Only the
superior posterior portion of the tongue moved forward
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 - answerA. An embedded
microsensor
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. Mallampati III allows visualization of only the hard palate
C. Mallampati 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 – answer D. Mallampati classifications of IV have
greater odds ratio than Mallampati classifications of I for severe OSA
What 8 item questionnaire was developed to perioperatively screen for risk of OSA?
A. ESS
B. STOP-BANG
C. MSLT
D. Berlin – answer B. STOP-BANG
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 - answerA. Increased lung volume
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 - answerE. None of the above
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 - answerD. The risk of HTN in
untreated OSA is due to intermittent hypoxia, sympathetic overactivation, inflammation,
and other complex factors
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 - answerD. Insomnia
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 - answerB. Increased muscle tone on inspiration
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 - answerB. Oxygen Desaturation
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 - answerB. The American Medical
Association
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 - answerB. Every 6 months for the first year, then annually
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 - answerB. Edentulism
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 - answerA. Stage I NREM
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 - answerD. All of the above
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 -
answerC. Oral appliance efficacy data collected in studies is obtained by dentist with
extensive clinical experience
, 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 - answerD. Additional
training or experience in dental sleep medicine
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 -
answerD. It contributes to the multifactorial nature of sleep related breathing disorders
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 - answerC. Sleep apnea patients demonstrate a more positive Pcrit
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 - answerB. Only the
superior posterior portion of the tongue moved forward
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 - answerA. An embedded
microsensor
