Bulletin of Dental Education Article

Sleep is a fundamental biological necessity, essential for physical restoration, cognitive function and overall health and well-being. Despite its importance, a significant portion of the population experiences chronic difficulties in obtaining adequate rest. The American Academy of Dental Sleep Medicine reports approximately 70 million Americans suffer from sleep-related disorders. Sleep deprivation has far-reaching consequences, negatively impacting cardiovascular, metabolic, cognitive and immune functions.

The National Institute on Aging notes older adults, in particular, face increasing sleep challenges due to a combination of physiological changes, chronic health conditions, medication effects and psychological stressors. Insufficient sleep has been associated with the increased risk of hypertension, heart disease, Type 2 diabetes, cognitive decline and accidental falls. Therefore, chronic sleep disturbances warrant medical attention and should not be underestimated.

Sleep disorders are generally classified into three main categories:

1. Central sleep apnea: A neurological condition wherein the brain fails to send appropriate signals to the muscles responsible for breathing.
2. Sleep-related hypoventilation/hypoxic syndrome: A complex condition often resulting from lower airway obstructions, pulmonary or vascular diseases, neuromuscular disorders or medication effects.
3. Obstructive sleep apnea (OSA): The most prevalent form—it is characterized by the repetitive partial or complete collapse of the upper airway during sleep, leading to airflow reduction and frequent arousals from sleep. Risk factors include obesity, enlarged tonsils, an enlarged soft palate or a large tongue.

One practical step for individuals experiencing ongoing sleep difficulties is to maintain a sleep diary and adopt consistent, healthy bedtime routines. When such efforts prove insufficient, professional consultation with a physician or dentist may be necessary.

According to Shaista Rashid, B.D.S., M.S., M.P.H., Interim Assistant Dean and Director of the Comprehensive Care Unit at A.T. Still University Missouri School of Dentistry & Oral Health (ATSU-MOSDOH), OSA is one of the most prevalent and serious forms of sleep-disordered breathing.

Shaista Rashid, B.D.S., M.S., M.P.H.

“OSA is a common condition characterized by repeated episodes of upper airway obstruction during sleep, which disrupts normal sleep architecture,” Dr. Rashid explains. “Untreated OSA has been linked through extensive research to numerous serious and potentially life-threatening health conditions involving the cardiovascular, immune, endocrine, cognitive and reproductive systems. It also significantly affects quality of life and day-to-day productivity. Notably, 24 hours of sleep deprivation can impair cognitive performance to the same extent as a blood alcohol concentration of 0.08%.”

The American Academy of Dental Sleep Medicine estimates 80–90% of sleep disorders remain undiagnosed. In 2015 alone, the economic burden of undiagnosed OSA was nearly $150 billion.

Dentists can play a critical role in the management of OSA by identifying potential cases during routine dental exams, referring patients to sleep specialists for diagnosis and providing oral appliance therapy as part of a comprehensive treatment plan.

Dr. Rashid is currently conducting research at the St. Louis Dental Center to assess dental students’ knowledge of OSA, and their awareness of the critical role dentists may play in early identification, screening and referral of patients at risk. Her study also seeks to identify gaps within the current dental curriculum related to sleep medicine, particularly with regard to theoretical instruction and clinical application.

Moreover, the study investigates dental students' confidence in recognizing the clinical signs and symptoms of OSA and their preparedness to initiate referrals for further medical evaluation or treatment. The findings are expected to inform the development of targeted educational modules designed to enhance students' competencies in sleep medicine. These modules aim to empower future dental professionals to recognize risk factors, conduct preliminary assessments and understand appropriate referral pathways—ultimately strengthening the collaborative role of dentists in interdisciplinary sleep health care.

Dr. Rashid emphasizes the importance of a patient-centered approach rooted in trust, compassion and education. Her goal is to ensure patients not only receive comprehensive oral health care but are also supported in recognizing and addressing conditions like sleep apnea, which have broad systemic health implications.

Courtesy of A.T. Still University Missouri School of Dentistry & Oral Health