Risk Factors for OSA Observed During Orofacial Examination: A Review

The American Dental Association in 2017 and the American Academy of Dental Sleep Medicine in 2018 recommended that dentists screen all patients for sleep-related breathing disorders, such as obstructive sleep apnea (OSA). The recommendations advised proper referral of those at increased risk of OSA to a medical provider for follow-up evaluation and diagnosis. Although several approaches to screening based on validated questionnaires are recommended for clinical practice, none has been formally validated for use with dental patients. These questionnaires assess the presence of symptoms of untreated OSA, such as excessive daytime sleepiness, and of established signs of the disorder such as snoring. It is generally accepted by dentists who practice dental sleep medicine that screening should query not only symptoms and signs of untreated OSA, but also consider relevant findings from the patient's medical history and orofacial examination. The purpose of this manuscript is to identify and review key findings in the orofacial clinical examination reportedly associated with an increased prevalence of OSA. Identification of these risk indicators may lead to the development and validation of informed screening paradigms for use in dental practice.