ABDSM Final Exam
Dental Sleep Medicine
ABDSM Final Exam – Dental Sleep Medicine
(Sample Questions & Answers)
1. What is the gold standard diagnostic test for Obstructive Sleep Apnea (OSA)?
1. Answer: The gold standard is overnight attended polysomnography (PSG) in a sleep
laboratory. PSG records multiple physiologic parameters including EEG, EOG, EMG, ECG,
airflow, respiratory effort, and oxygen saturation, allowing precise measurement of the apnea-
hypopnea index (AHI). Home sleep apnea testing (HSAT) is an alternative in selected patients,
but PSG remains the most comprehensive.
2. Define the Apnea-Hypopnea Index (AHI) and its role in classifying OSA
severity.
Answer: The AHI represents the average number of apneas (complete airflow cessation ≥10
seconds) and hypopneas (partial airflow reduction with desaturation or arousal) per hour of sleep.
Mild OSA: AHI 5–14
Moderate OSA: AHI 15–29
Severe OSA: AHI ≥30
This classification guides treatment selection, including oral appliance therapy, CPAP, or surgical
intervention.
3. What are the primary indications for oral appliance therapy (OAT) in OSA
patients?
Answer: OAT is indicated for:
1. Patients with mild to moderate OSA who prefer OAT over CPAP.
2. Severe OSA patients who are intolerant of CPAP or refuse CPAP.
3. Primary snorers without OSA who desire treatment.
The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep
Medicine (AADSM) recommend OAT as a first-line therapy in these cases.
4. Describe how mandibular advancement devices (MADs) reduce airway
obstruction in OSA.
, 1. Answer: MADs reposition the mandible anteriorly and inferiorly, which in turn:
Enlarges the retropalatal and retroglossal airway space,
Reduces pharyngeal collapse,
Stabilizes the tongue and soft tissues,
Increases upper airway muscle tone.
This biomechanical action reduces apneas and hypopneas during sleep.
5. What are the most common side effects of long-term oral appliance therapy?
Answer:
Short-term: Excessive salivation, dry mouth, gum irritation, and transient tooth/jaw discomfort.
Long-term: Permanent occlusal changes (posterior open bite, decreased overjet/overbite), tooth
movement, temporomandibular joint (TMJ) discomfort, and changes in mandibular posture.
Monitoring and regular dental follow-up are critical to minimize progression.
6. What is the role of dentists in the multidisciplinary management of OSA?
Answer: Dentists trained in dental sleep medicine:
Evaluate oral and craniofacial structures for OAT suitability,
Fabricate and titrate oral appliances,
Monitor side effects and manage occlusal changes,
Communicate with sleep physicians regarding efficacy, compliance, and follow-up PSG results.
They act as essential collaborators in integrated sleep medicine care.
7. Which anatomical and clinical factors predict better success with OAT?Answer:
Predictors of better response include:
Milder OSA severity (AHI <30),
Lower body mass index (BMI <30),
Supine-dependent OSA,
Younger age,
Adequate dentition for device retention,
Absence of significant nasal obstruction.
Patients with severe obesity or craniofacial abnormalities tend to have poorer outcomes.
8. What is positional OSA, and how does it influence treatment?
Answer: Positional OSA occurs when the AHI is at least twice as high in the supine position
compared to non-supine. These patients may benefit from positional therapy (avoiding supine
sleep), which can be used alone in mild cases or combined with OAT or CPAP for improved
outcomes.
9. Compare CPAP and OAT in terms of efficacy and compliance.
Answer:
CPAP: More effective at reducing AHI to normal levels across all severities.
Dental Sleep Medicine
ABDSM Final Exam – Dental Sleep Medicine
(Sample Questions & Answers)
1. What is the gold standard diagnostic test for Obstructive Sleep Apnea (OSA)?
1. Answer: The gold standard is overnight attended polysomnography (PSG) in a sleep
laboratory. PSG records multiple physiologic parameters including EEG, EOG, EMG, ECG,
airflow, respiratory effort, and oxygen saturation, allowing precise measurement of the apnea-
hypopnea index (AHI). Home sleep apnea testing (HSAT) is an alternative in selected patients,
but PSG remains the most comprehensive.
2. Define the Apnea-Hypopnea Index (AHI) and its role in classifying OSA
severity.
Answer: The AHI represents the average number of apneas (complete airflow cessation ≥10
seconds) and hypopneas (partial airflow reduction with desaturation or arousal) per hour of sleep.
Mild OSA: AHI 5–14
Moderate OSA: AHI 15–29
Severe OSA: AHI ≥30
This classification guides treatment selection, including oral appliance therapy, CPAP, or surgical
intervention.
3. What are the primary indications for oral appliance therapy (OAT) in OSA
patients?
Answer: OAT is indicated for:
1. Patients with mild to moderate OSA who prefer OAT over CPAP.
2. Severe OSA patients who are intolerant of CPAP or refuse CPAP.
3. Primary snorers without OSA who desire treatment.
The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep
Medicine (AADSM) recommend OAT as a first-line therapy in these cases.
4. Describe how mandibular advancement devices (MADs) reduce airway
obstruction in OSA.
, 1. Answer: MADs reposition the mandible anteriorly and inferiorly, which in turn:
Enlarges the retropalatal and retroglossal airway space,
Reduces pharyngeal collapse,
Stabilizes the tongue and soft tissues,
Increases upper airway muscle tone.
This biomechanical action reduces apneas and hypopneas during sleep.
5. What are the most common side effects of long-term oral appliance therapy?
Answer:
Short-term: Excessive salivation, dry mouth, gum irritation, and transient tooth/jaw discomfort.
Long-term: Permanent occlusal changes (posterior open bite, decreased overjet/overbite), tooth
movement, temporomandibular joint (TMJ) discomfort, and changes in mandibular posture.
Monitoring and regular dental follow-up are critical to minimize progression.
6. What is the role of dentists in the multidisciplinary management of OSA?
Answer: Dentists trained in dental sleep medicine:
Evaluate oral and craniofacial structures for OAT suitability,
Fabricate and titrate oral appliances,
Monitor side effects and manage occlusal changes,
Communicate with sleep physicians regarding efficacy, compliance, and follow-up PSG results.
They act as essential collaborators in integrated sleep medicine care.
7. Which anatomical and clinical factors predict better success with OAT?Answer:
Predictors of better response include:
Milder OSA severity (AHI <30),
Lower body mass index (BMI <30),
Supine-dependent OSA,
Younger age,
Adequate dentition for device retention,
Absence of significant nasal obstruction.
Patients with severe obesity or craniofacial abnormalities tend to have poorer outcomes.
8. What is positional OSA, and how does it influence treatment?
Answer: Positional OSA occurs when the AHI is at least twice as high in the supine position
compared to non-supine. These patients may benefit from positional therapy (avoiding supine
sleep), which can be used alone in mild cases or combined with OAT or CPAP for improved
outcomes.
9. Compare CPAP and OAT in terms of efficacy and compliance.
Answer:
CPAP: More effective at reducing AHI to normal levels across all severities.
