In a recent position statement, the American Academy of Sleep Medicine and the American Medical Association argue that only licensed physicians are qualified to order and interpret home sleep apnea tests.
In May of this year, the American Academy of Sleep Medicine (AASM) got the American Medical Association (AMA) on board to try to block dentists and other non-licensed-physician healthcare practitioners from using home sleep apnea tests (HSAT) to diagnose obstructive sleep apnea (OSA). According to the AASM article announcing its advocacy of this initiative, the position statement is meant to “defend the scope of practice of physicians and advanced care providers who manage patients with obstructive sleep apnea from encroachment by dentists and other practitioners, who are not trained or qualified to diagnose a medical disease.”
So how long has this resolution been in the works? AASM president Douglas Kirsch, MD, says it has been on their radar for quite some time. “In recent years, questions about the dentist’s role in the treatment of sleep-disordered breathing have been raised by dental boards in states such as Texas, Georgia, and Colorado,” he says. “The AASM has been working with members in these states, and with their state medical societies, to ensure that dental boards consider the medical perspective when evaluating the scope of practice of dentists.”
Kirsch adds that to make this perspective readily available to both dental boards and medical boards in every state, the AASM developed the position statement and introduced a resolution in the American Medical Association House of Delegates. The AMA declined to comment on this article, referring the reporter to the AASM.
Dentists might be wondering if the resolution is intended to be interpreted that at no time should they be using home sleep testing. Is screening allowed before sending the patient to a physician if the HSAT result is positive? How about titration before sending the patient back to the sleep lab for an efficacy check? Kirsch says no, and that all testing should be done by a licensed physician.
“It is the position of the AASM (and the AMA) that ‘ordering and interpreting objective tests aiming to establish the diagnosis of OSA or primary snoring constitutes the practice of medicine.’ Only a medical practitioner who is licensed to practice medicine should use a home sleep apnea test to evaluate a patient,” he says. “Therefore, a home sleep apnea test should not be used by a dentist as part of a clinical evaluation.”
Kirsch notes that despite their position, it’s important to emphasize that the AASM has no authority over the practice of dentistry.
Keith Thornton, DDS, ABDSM, a Dallas, Texas-based dentist and inventor of numerous devices that treat sleep-related breathing disorders including the TAP, says, “I think it is sad and unfortunate that the AASM has opted to pursue their approach on sleep related breathing disorders (SRBD) by legally accusing dentists of practicing medicine without a license. Certainly, their action has upset many dentists and the House of Delegates of the American Dental Association for advocating a restriction on the scope of the practice of dentistry. Professional practices, including medicine and dentistry, are regulated by state law, which is ultimately determined by state legislatures.”
When asked if advocating in this way will alienate physicians from dentists, AASM’s Kirsch says professional collaboration between dentists and physicians is most effective when their roles and responsibilities are clearly defined. “The AASM encourages qualified dentists to work closely with a board-certified sleep medicine physician at an AASM-accredited sleep center to provide high quality, patient-centered care for individuals who have sleep-disordered breathing,” he says.
The outcome of the position statement desired by the AASM, says Kirsch, is for every patient with suspected OSA to be accurately diagnosed and effectively treated. He adds, “Achieving this outcome will require effective collaboration between sleep physicians, other licensed medical providers, and qualified dentists, each practicing within the boundaries of their scope of practice to provide exceptional patient care.”
Some clinicians advocate from a different viewpoint. “My recommendation,” says Thornton, “would be for the AASM to recruit the 180,000 practicing dentists to work together to screen and treat patients with uncomplicated SRBD….Patients need all the help they can get in managing this public health problem.”
Dillon Stickle is associate editor of Sleep Review.