When we choose to treat Sleep Disordered Breathing (SDB) in our dental offices, we take on a set of increased responsibilities. Thorough data collection is important in dentistry; it’s even more important in dental sleep medicine.

In order to efficiently and effectively treat our patients for sleep apnea there is a certain protocol that we have to follow and we must be aware of our patient’s medical history. A history of present illness (HPI) is a key component to this algorithm of treating our patients that have been diagnosed with SDB.

The HPI is simply the chronology of the patient’s health issues since the first sign of sleep apnea or their last visit. The HPI consists of eight different elements:
  1. Location

  2. Severity

  3. Quality

  4. Context

  5. Timing

  6. Duration

  7. Modifying Factors

  8. Associated Signs


There are two levels of the HPI; brief and extended. One to three elements must be included in the write up to meet the requirement of a brief HPI and an extended HPI must include at least four of those elements. An extended HPI looks similar to the clinical example below:

CC: Sleep Apnea

HPI: Patient was told of snoring and gasping by bed partner since 1995. No complaints unless supine. He does not notice any daytime sleepiness. PCP noted HTN and referred to sleep doc. Sleep study found mild OSA and tried CPAP for three nights but discontinued use due to discomfort.

In that example, four elements are covered: severity, context, duration and associated signs. Just remember, there aren’t any shortcuts when it comes to the HPI; this information must be recorded by you and not by a member of your staff. It is OK for the patient to fill out a questionnaire as long as the doctor notes that specifically he or she reviewed it.  More informative is the doctor simply mastering this short list of topics and recording the findings of a conversation during the preclinical interview.

Comments

Commenter's Profile Image Fiona Neill
September 3rd, 2013
So what if the patient comes in complaining about her CPAP, and says she has heard of this night guard like device that can help her. Do you still send them for sleep study? How do you approach for a Silent-Nite or similar device?
Commenter's Profile Image Steve Carstensen
September 3rd, 2013
If your patient already has a CPAP, she won't need another sleep study. You can get in touch with the diagnosing physician and see if she might be a candidate for Oral Appliance Therapy. If that's true, then a trained dentist can provide that for her, possibly greatly improving her health if she'll use that new device where she avoided using the CPAP before. Silent-Nite is one of more than a hundred FDA approved devices for treating obstructive sleep apnea.