Assessment of the knowledge and awareness among general medical practitioners toward dental intervention in diagnosing and treating obstructive sleep apnea: a cross-sectional study

Abstract

Background

Obstructive Sleep Apnea (OSA), one of the most common sleep disorders, is associated with a large amount of morbidity to both the heart and metabolic function. Continuous Positive Airway Pressure (CPAP) remains the gold standard treatment for patients with OSA. In contrast, Dental treatments such as Mandibular Advancement Devices (MADs) are considered well-established alternatives for certain patients. Since General Practitioners (GPs) often initiate the diagnostic and therapeutic management of these patients, the extent of their understanding of dental and craniofacial management options remains unclear.

Materials and methods

An electronic cross-sectional survey was conducted among licensed Medical Practitioners from both the Allopathic and AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy) streams. A 15-question questionnaire was used to assess four domains: (1) Aetiology, (2) Diagnosis, (3) Treatment, and (4) Referral Practices. Responses (“Agree,” “Disagree,” “Not aware”) were recorded and converted to a binary system for analysis, where Agree equals 1 and Disagree/Not aware equals 0. Descriptive statistics and Chi-square tests will help analyse the variation between domains at a statistically significant level (p < 0.05).

Results

Diagnostic awareness was moderate, with 57.6% identifying polysomnography (PSG) as the gold standard test. There was a deficiency in knowledge on the available treatment options: only half of them recognized MADs as efficient. The composite scoring provided a moderate knowledge score (6.72 ± 3.08) and significantly lower mean awareness score (1.79 ± 0.73). There was great heterogeneity between domains (χ2 = 127.31, df = 36, p = 0.0001) as familiarity with dental and craniofacial and referral-related aspects of OSA care was inconsistent.

Conclusion

GPs showed a greater level of awareness of general diagnostic concepts compared to craniofacial risk factors, oral appliance therapy, or interdisciplinary referral pathways. Specific educational programs and organized medical-dental partnership models should be established in order to enhance integrated management of OSA.

Introduction

Obstructive Sleep Apnea (OSA) is a disease that has become one of the most widespread chronic illnesses in the world today, as about one out of every ten adults is affected by the disease [1–3]. The rising incidence of OSA has been linked to the increased population of overweight/obese individuals and rising levels of cardiometabolic diseases [2].In addition, the recent rapid urbanisation has resulted in the development of an increasing number of undiagnosed cases of OSA, with an estimated 25 per cent or more of the population having untreated OSA [3]. The high prevalence of habitual snoring, witnessed apneas, and excessive daytime sleepiness is consistently reported in all the studies conducted to date [4, 5]. Without appropriate treatment, OSA leads to numerous adverse effects on the cardiovascular, metabolic, and neurocognitive health of the patient, highlighting the necessity of early recognition and prompt referral [6–8].

The gold-standard treatment for moderate to severe OSA is Continuous Positive Airway Pressure (CPAP) [9]. CPAP provides adequate physiological effect for the treatment of moderate to severe OSA as long as patients adhere to their CPAP therapy [10–12]. Despite behavioural interventions and support follow-up programs that assist patients in improving their use of CPAP therapy, adherence to CPAP therapy in a real-world setting has not improved for many OSA patients [13, 14]. Because of these limitations, increasing the awareness amongst the primary care physicians regarding the alternative and/or supplemental solutions to treat OSA, such as Lifestyle modifications, Surgical management, Laser Therapy, and Oral devices such as tongue-retaining devices, Palatal Lifters, MADs, etc. may prove to be beneficial [15]. As a result, physicians are likely to face an increasingly diverse therapeutic environment as the primary point of contact for these patients with symptoms [16–18].

Oral appliance therapy, particularly MADs, is now well established as an evidence-based treatment for patients with mild to moderate OSA or for those who are intolerant to CPAP [19]. MADs enhance upper airway patency by anteriorly repositioning the mandible and have demonstrated favourable comfort and compliance compared with CPAP [20–22]. Despite this, misconceptions persist among physicians regarding indications, expected outcomes, and referral processes for dental sleep medicine interventions [23].

GPs play a crucial role in recognising and treating OSA [24]. Most GPs regularly assess patients with the symptoms of heavy snoring, uncontrolled high blood pressure, unexplained daytime sleepiness, or heart problems [25, 26]. However, studies show that the level of knowledge that GPs have regarding the role of dentists in managing OSA is significantly lacking [27]. There is also low awareness of the American Academy of Dental Sleep Medicine (AADSM’s) recognised training standards, which are new and are necessary to provide adequate training for professionals to deliver effective Apnea care [28, 29]. Hence, this study aims to assess and measure the knowledge level and awareness of the GPs about OSA, its possible causes, diagnosis, available treatment options & the need for a referral to a specialized Dentist [30].

Materials and methods

Ethical aspects

An approval for the study was received from the Institutional Ethical Committee (Ref. no- DMIHER(DU)/IEC/2025/757). The Cross-sectional study began only after receiving approval. Informed consent was obtained from all the participants prior to the study.

Study design

A descriptive cross-sectional survey was conducted to assess GPs knowledge and awareness regarding dental involvement in the diagnosis and management of OSA.

Study setting and duration

The data collection took place via an online survey sent out over a pre-set three-month timeframe via email.

Participants

The participants were licensed medical practitioners who were actively involved in clinical practice in allopathic (MBBS, MD, MS, DNB) and AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy) streams. It represents a distinct stream of medical education and practice, operating under its own ministry (Ministry of Ayush) to provide holistic, preventive, and cost-effective treatment alongside modern medicine. As these practitioners often first come into contact with OSA patients in India during Primary care screening, their awareness regarding dental intervention in sleep apnea care holds significant importance, which in turn will affect the referral pathway.

Sample size justification

At least 100 subjects were considered to be sufficient to identify medium effect sizes in chi-square-based awareness comparisons (power = 0.80, α = 0.05). The obtained sample (n = 125) was large enough and comparable to prior awareness research in sleep medicine. One hundred and twenty-five of the total answers were evaluated.

Inclusion and exclusion criteria

Inclusion criteria

The study included licensed medical practitioners who were actively engaged in treating patients.

Exclusion criteria

The study excluded incomplete questionnaire answers and duplicate responses.

Sampling technique

Voluntary sampling was based on convenience, with the addition of snowball recruitment through professional networks.

Questionnaire development and validation

The questionnaire was well framed and consisted of 15 items under four domains, namely aetiology (4 items), diagnosis (3 items), treatment (5 items), and referral practices (3 items) (Table 1). Each of the domains included questions that were aimed at measuring and comparing the level of knowledge of the GPs in reference to dental intervention. This was formulated on the basis of the studies conducted of a similar nature [11]. A panel of experts was constituted to review the questionnaire to analyse it with respect to dental intervention in OSA. The panel has also taken into account the face validity of the questionnaire as well as its design and structure. They evaluated the appropriateness of questions to estimate the relevant field. The alpha of Cronbach in the test questionnaire was 0.7, which concluded that the internal consistency of the questionnaire used in the study was good, and the test-retest and Kappa (0.80) were used to establish reliability. Pilot testing was used on 12 practitioners to ensure clarity and response. A prosthodontist, a dental sleep medicine specialist, and a sleep physician determined content validity.

Table 1.

The study questionnaire

SECTION 1: ETIOLOGY LEADING TO OSA
Item Statement	Scale
1. Malocclusion is a significant factor leading to the development of OSA.	Agree	Disagree	Not aware
2. Recessed mandible (retrognathia) causes airway collapse during sleep, contributing to OSA.	Agree	Disagree	Not aware
3. Macroglossia is positively associated with OSA.	Agree	Disagree	Not aware
4. High-arched palate and OSA coexist frequently	Agree	Disagree	Not aware
SECTION 2: EXAMINATION AND DIAGNOSIS FOR OSA
Item Statement	Scale
5. Radiographic evaluation (CBCT) can enhance the assessment of oral anatomy to diagnose OSA.	Agree	Disagree	Not aware
6. Neck circumference measurement is a helpful diagnostic indicator of OSA.	Agree	Disagree	Not aware
7. Polysomnography done by sleep medicine therapist is of utmost diagnostic value for diagnosing OSA.	Agree	Disagree	Not aware
SECTION 3: TREATMENT
Item Statement	Scale
8. Orthognathic surgery performed by oral and maxillofacial surgeons is an effective and viable treatment option for patients with moderate to severe OSA.	Agree	Disagree	Not aware
9. CPAP is the gold standard for severe OSA.	Agree	Disagree	Not aware
10. Oral appliance such as Mandibular Advancement devices are effective treatment modality for mild to moderate OSA.	Agree	Disagree	Not aware
11. Palatal lifters are a suitable treatment option for mild to moderate OSA in patients with palatal insufficiency and incompetency.	Agree	Disagree	Not aware
12. Lifestyle change provides the most effective treatment for patients with mild to moderate OSA.	Agree	Disagree	Not aware
SECTION 4: REFERRAL
Item Statement	Scale
13. A multidisciplinary approach involving medical and dental professionals is essential for effective OSA care.	Agree	Disagree	Not aware
14. Lack of awareness about dental treatment options for OSA limits my referrals to dentists.	Agree	Disagree	Not aware
15. Are you aware of the AADSM Mastery Program that certifies dentists to provide snoring and sleep apnea solutions?	Agree	Disagree	Not aware

Scoring

The analysis was split into three responses: “Agree, Disagree, Not aware.”

Agree = 1; Disagree/Not aware = 0.

Among the 15 questions, those numbered 1 to 12 were used to assess knowledge, and those numbered 13 to 15 were used to assess awareness. Composite scores were obtained with regard to: The Knowledge Score (aetiology + diagnosis + treatment; range 0–12), Awareness Score ( items related to referral; range 0–3). This dichotomous system of scoring is consistent with previous research in awareness that focused on recognition and a lack of knowledge [31].

Data collection

Institutional mailing lists and clinician networks were used to send the questionnaire through Google Forms. The responses were analyzed in a secure spreadsheet of those that were completed. Two discrete missing responses identified on Q11 and Q12 (0.8% each) were re-coded as system-Missing and left out in item-level percentage calculations.

Statistical analysis

The SPSS v27 was used to analyse the data. Item-wise responses were summarised using frequencies and percentages. There were manual checks on data to ensure that there were no incomplete or incorrect entries. Frequency distributions were compared to raw response sheets provided by the statistician.

Chi-square testing was done at two levels:

1. Comparisons at the item level across domains in a bid to assess response variability.

2. Domain-level comparisons to determine variation in etiological, diagnostic, treatment, and referral constructs.

Means and standard deviations were used to summarise Composite Knowledge and Awareness scores. Significance was set at p < 0.05. The total number of frequency and percentage figures in Tables 3, 4, 5 and 6 are based on the overall confirmed data of 125 participants (Tables 3, 4, 5 and 6).

Table 3.

Awareness of Diagnostic Approaches for OSA (N = 125)

Item (Abbreviated)	Agree n (%)	Disagree n (%)	Not aware n (%)
CBCT for airway assessment	80 (64.0)	14 (11.2)	31 (24.8)
Neck circumference as indicator	96 (76.8)	15 (12.0)	14 (11.2)
Polysomnography as gold standard	72 (57.6)	27 (21.6)	26 (20.8)

Table 4.

Awareness of Treatment Modalities for OSA (N = 125)

Item (Abbreviated)	Agree n (%)	Disagree n (%)	Not aware n (%)
Orthognathic surgery effectiveness	43 (34.4)	48 (38.4)	34 (27.2)
CPAP as gold standard	78 (62.4)	14 (11.2)	33 (26.4)
MADs effective for mild–moderate OSA	63 (50.4)	18 (14.4)	44 (35.2)
Palatal lifters usefulness	46 (36.8)	35 (28.0)	43 (34.4)
Lifestyle modification benefit	73 (58.4)	13 (10.4)	38 (30.4)

Table 5.

Referral Practices and Interdisciplinary Awareness (N = 125)

Item (Abbreviated)	Agree n (%)	Disagree n (%)	Not aware n (%)
Need for medical–dental collaboration	92 (73.6)	8 (6.4)	25 (20.0)
Limited dental-OSA awareness hinders referral	114 (91.2)	5 (4.0)	6 (4.8)
Awareness of AADSM training	18 (14.4)	4 (3.2)	103 (82.4)

Table 6.

Summary of Awareness Across Domains and Key Gaps

Domain	Mean Agree (%)	Biggest Strength	Biggest Weakness
Etiology	57.8	High recognition of malocclusion	Low awareness of high-arched palate
Diagnosis	66.1	Strong recognition of neck circumference	Suboptimal PSG awareness
Treatment	48.5	CPAP recognition	Low awareness of MADs & surgery
Referral	59.7	Support for collaboration	Extremely low awareness of AADSM program

Table 2.

Awareness of Aetiological Factors Associated with OSA (N = 125)

Item (Abbreviated)	Agree n (%)	Disagree n (%)	Not aware n (%)
Malocclusion as risk factor	98 (78.4)	6 (4.8)	21 (16.8)
Retrognathia & airway collapse	51 (40.8)	35 (28.0)	39 (31.2)
Macroglossia association	76 (60.8)	16 (12.8)	33 (26.4)
High-arched palate association	64 (51.2)	13 (10.4)	48 (38.4)

Results

The outcome was derived by the analysis of 125 complete responses.

Awareness of etiological factors

There was a significant difference in awareness of craniofacial contributors to OSA. The aetiological factor that was most commonly identified was malocclusion (78.4%). The 60.8% of respondents recognized macroglossia. Knowledge about retrognathia was significantly less (40.8% agreement; 31.2% unaware). The highest knowledge gap was found to be in the high-arched palate, where 38.4% of the respondents said they did not know that it can be related to OSA. Generally, the respondents showed moderate knowledge of common craniofacial risk factors but had less knowledge of structural airway factors other than malocclusion.

Table 3 shows the distribution of responses to aetiological items. In general, there was an average aetiological awareness with a consistent discrepancy in craniofacial feature recognition.

Awareness of diagnostic modalities

There was a significant variability in the case of diagnostic awareness (Table 4). Most people (76.8%) stated that the neck circumference is a good screening measure. Only 57.6% of them identified PSG as the gold-standard diagnostic test correctly. Cone Beam Computed Tomography (CBCT) was considered a supplementary anatomical evaluation tool by 64.0%, and almost a quarter of the respondents did not know its purpose. These findings are an indicator of greater knowledge of general clinical predictors as compared to advanced diagnostic tools in dental sleep medicine.

Table 4 provides an overall overview of item-level knowledge of diagnostic methods. There was a relatively high level of diagnostic knowledge, but the PSG familiarity was still suboptimal.

Awareness of treatment modalities

The awareness on the availability of treatment varied among items (Table 5). The 62.4% identified CPAP as the gold-standard treatment of severe OSA. A low awareness of MADs as an evidence-based intervention in mild-moderate OSA was found (50.4%). The level of awareness was low (34.4% agreement; 27.2% unaware) regarding orthognathic surgery. Knowledge of palatal lifters was also poorly represented (36.8% agreement). Only 58.4% of respondents recognized lifestyle modification as beneficial. Such results demonstrate the obvious gap in knowledge about dental and maxillofacial treatment plans. The palatal lifter and lifestyle modification items had two entries (0.8%) system-missing; these were not interpreted according to recoding guidelines. Treatment awareness had the lowest score, especially when it comes to dental and maxillofacial modalities.

Referral practices and interdisciplinary awareness

The weakest area was the referral-level awareness (Table 6). The majority of the respondents (73.6%) admitted that medical-dental collaboration is significant to OSA care; 91.2% stated that they lack knowledge about dental treatment options, which means that they have limited access to dental sleep medicine training pathways. Figure 1 represents the awareness distribution concerning the AADSM Dental Sleep Medicine Mastery Program. Awareness at the referral level showed the greatest variation, which was largely due to the lack of awareness of the AADSM certification pathways (Fig. 1).

Fig. 1.

AADSM Awareness Pie Chart

Summary of domain-level awareness

Mean agreement levels across domains showed: Awareness about Diagnosis to be 66.1% (the strongest performance), Aetiology as 57.8%, Treatment as 48.5% and Referral as 59.7% (but with extremely low program awareness). Cross-domain patterns illustrate consistent familiarity with fundamental medical aspects of OSA, contrasted by limited awareness of craniofacial determinants and dental interventions. A consolidated summary of domain-level awareness patterns, including strengths and weaknesses, is shown in Table 7. Figure 2 illustrates domain-wise awareness comparisons.

Table 7.

Distribution of Composite Knowledge and Awareness Scores (N = 125)

Score Range	Knowledge n (%)	Awareness n (%)
0–3 (Low)	22 (17.6)	78 (62.4)
4–7 (Moderate)	57 (45.6)	42 (33.6)
8–12 (High)	38 (30.4)	5 (4.0)

Fig. 2.

Domain-Wise Awareness Comparison (Bar Chart)

Composite knowledge and awareness scores

The average composite knowledge score was 6.72 on a scale of 1–12 (with a Standard Deviation of 3.08); this indicates the majority of respondents showed some familiarity with the fundamental concepts, but the range of results varied greatly. Conversely, Respondents’ average Awareness score was only 1.79 on a scale of 1–3 (with a Standard Deviation of 0.73). Respondents’ low awareness score suggests that they were ill-equipped to recognize when dental interventions might be needed or to determine the appropriate pathway to obtain dental referrals in such situations. A correlation exists between knowledge and awareness (X^2 = 127.31, df = 36, p < 0.0001) based on a Chi-Square Analysis; however, the pattern of how respondents answered indicates that while an increase in factual knowledge does not reliably correlate with a higher likelihood of making referrals. Evidence of this gap can also be seen in Table 7.

Inferential analysis across domains

Significant variability was observed within each domain:

• Aetiology: χ² = 53.82, df = 6, p < 0.001; Cramer’s V = 0.46.

• Diagnosis: χ² = 15.67, df = 4, p = 0.003; Cramer’s V = 0.25.

• Treatment: χ² = 55.88, df = 8, p < 0.001; Cramer’s V = 0.42.

• Referral: χ² = 187.59, df = 4, p < 0.001; Cramer’s V = 0.61.

The strongest variability occurred in the referral domain, indicating wide disparities in interdisciplinary awareness.

Domain-level comparison also revealed significant overall differences in response distribution (χ² = 75.49, df = 6, p < 0.001), with the highest performance in diagnosis and the greatest deficits in referral practices.

Discussion

This study assessed general medical practitioners’ knowledge and awareness across aetiological, diagnostic, therapeutic, and referral domains related to OSA. The results demonstrate a regular pattern: a moderate level of factual knowledge and significantly poor awareness of dental and interdisciplinary aspects, and most importantly, those that are needed to provide integrated OSA care. The close correlation between Knowledge and Awareness scores (χ 2 = 127.31, df = 36, p < 0.0001) suggests that these deficits are systematic, not random. There were three different areas where practitioner performance was lowest. Craniofacial risk factors were generally not well recognised by most individuals. Individuals’ understanding of craniofacial conditions (e.g., retrognathia, narrow maxilla, or high palate) did not develop as a result of their understanding of the apparent signs of malocclusion [28–30]. This continues to support previous studies, such as that conducted by Smith et al., that demonstrate craniofacial morphology is generally not included in OSA assessments completed by practitioners of OSA [32]. The average composite mean score for craniofacial knowledge was 6.72 ± 3.08, representing a broad range of variability in individuals’ understanding of these craniofacial characteristics at the time of their first visit [33].

The level of awareness among practitioners regarding diagnostic testing for diagnosing OSA was moderate. Nearly all respondents reported being aware of neck circumference measurement as a useful screening tool; however, fewer than 60% correctly identified PSG as the gold standard for diagnosing OSA. Similarly, knowledge of CBCT and other types of diagnostic imaging was inconsistent, suggesting that dental radiographic knowledge was not being incorporated into diagnostic assessments of OSA [34–36].

Therapeutic knowledge was the weakest area apart from referrals. Only half of the respondents were aware that MAD would be effective treatments for mild to moderate OSA and that surgical management was rarely considered [37–40]. Referral knowledge demonstrated the most significant gaps, with an average awareness score of only 1.79 ± 0.73. More than 80 per cent of respondents had no knowledge of formal dental sleep medicine continuing education programs, including the AADSM Clinical Mastery Program. Limited understanding of provider qualifications and indications for referral creates a barrier to safe and appropriate multidisciplinary management [41, 42].

The lower diagnostic and craniofacial awareness in this cohort contrasts with earlier studies, as conducted by Barnes et al., which reported stronger recognition of PSG and craniofacial features [43]. There are three contextual explanations that are plausible. To start with, the MBBS undergraduate programmes expose students to little dental anatomy, craniofacial development, or functional airway assessment, compared to previous cohorts who were exposed to more anatomy-focused curricula. Second, Indian medical and dental systems are mainly parallel systems with limited interdisciplinary training and referral systems. Third, continuing professional development (CPD) in India tends to prioritise cardiometabolic updates; sleep medicine topics, particularly dental-sleep interfaces, receive limited focus. Prior studies that sampled specialists or conference-attending clinicians would therefore overestimate general practice awareness relative to the broader practitioner base captured in this study [44–48].

A significant barrier to optimal patient care regarding the craniofacial aspects of OSA, including diagnosis and referral for dental treatment and the use of oral appliances, is the lack of knowledge in these areas. Due to inadequate clinician training and a lack of understanding of the craniofacial aspects of OSA, multiple cases have been reported in the literature, leading to delayed diagnosis, misclassification of disease severity, and inability to identify appropriate patients for treatment. In addition to an insufficient understanding of the craniofacial aspect of OSA, many patients will not receive effective treatment options if the physician or dentist is unfamiliar with these treatment modalities, forcing the patients to undergo more invasive CPAP therapy, as well as the unnecessary burden of keeping these patients in a sleep laboratory for an excessive amount of time. The overall lack of awareness of referral requirements and required training contributes to delays in appropriate referrals, further reducing the quality of patient care.

The following recommendations focusing on education and system-level change have been determined as the most important areas to put resources and effort into:

• Curriculum Updates: Adding structured modules to all MBBS programs on the craniofacial assessment and oral appliance therapy, as well as specific referral criteria for both disciplines, would create a better foundation of competencies for residents.

• Competency-based CDE Programs: Continuing education (CE) programs must provide education on how to read the results of a PSG test and when to refer for oral appliance therapy or surgical intervention, as well as create interdisciplinary algorithms for referring patients to other medical and dental professionals. CE Programs such as the AADSM Mastery Program provide a standard for physicians and dentists to help them make consistent referral decisions.

• National Referral Guidelines: The AADSM Mastery Program is the premier educational program for dentists in the United States of America who want to provide snoring and sleep apnea solutions. The program is inclusive of two intensive levels - Mastery 1 and Mastery 2. The AADSM has established national referral guidelines that delineate who qualifies for treatment of OSA and the criteria for oral appliance therapy (OAT). These guidelines will provide further assistance in establishing uniformity in practice.

• Integration of Care: Incorporating dentists into sleep medicine practices and establishing digital referral pathways for GPs to connect patients with dental specialists will help break down barriers within the current healthcare system.

This study, hence, provides a basis to bridge the gap and promote a multidisciplinary approach in OSA care.

Limitations of the present study

In the interpretation of the findings, there are a number of limitations involved in this study. Selecting convenience sampling can also have brought about selection bias, which could have contributed to the lack of representativeness of the study population. Though a digital platform was used to recruit participants, the sample might not be overall representative of the practitioners in the different geographic locations, especially those working in rural or underrepresented areas. Also, the use of a self-reported questionnaire makes response bias, such as recall bias and social desirability bias, possible and, consequently, affects the accuracy of the data reported. There was a lack of demographic variables collected, which limited the possibility of doing subgroup analysis or determining how the characteristics of the participants affected the results. Although the study sample (n = 125) was statistically satisfactory, a bigger and more multicentric research with a more heterogeneous and systematically chosen population would increase the generalizability and external validity of the results.

Further scope

The present study provides a structured evaluation of GPs knowledge and Awareness regarding dental intervention in OSA care. It provides a strong insight into the limited referral practice, which will help promote various educational programmes and the development of targeted continuing medical education (CME) programmes. It will form a basis for inculcating dental sleep medicine into the curriculum for undergraduate and postgraduate medical training. Inclusion of programs related to dental sleep medicine, similar to AADSM under the Indian Dental Association (IDA), will certainly help to improve the quality of sleep apnea care in India.

Conclusion

The survey results indicate that most GPs are unaware of the craniofacial factors associated with OSA and the role of dentists and their procedures in the diagnosis and treatment of this condition. GPs have limited knowledge about the various treatment options available for patients who are unable or unwilling to use CPAP machines due to this lack of understanding. Therefore, GPs are unsuccessful in making a proper referral to the correct type of dental sleep medicine specialist. Educating and training GPs, along with providing them with additional resources, will enable them to more effectively identify and refer patients who are suitable for dental sleep medicine specialists. Incorporating dental sleep medicine into the integrated clinical management of all patients diagnosed with OSA may also reduce delays between diagnosis and the commencement of treatment, creating a more holistic and comprehensive, patient-centred approach to managing OSA.

Abbreviations

OSA

Obstructive Sleep Apnea

CPAP

Continuous Positive Airway Pressure

MAD

Mandibular Advancement Device

GP

General Practitioner

AADSM

American Academy of Dental Sleep Medicine

MBBS

Bachelor of Medicine, Bachelor of Surgery

MD

Doctor of Medicine

MS

Master of Surgery

DNB

Diplomate of National Board

AYUSH

Ayurveda, Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa, and Homeopathy

BAMS

Bachelor of Ayurvedic Medicine and Surgery

BHMS

Bachelor of Homeopathic Medicine and Surgery

CBCT

Cone Beam Computed Tomography

PSG

Polysomnography

CME

Continuing Medical Education

Authors’ contributions

The ICMJE criteria determine authorship eligibility. AA and SN contributed to the concept, design, and the drafting of the manuscript of the study. VB and SG interpreted the data for the work. NZ, RM and PN were involved in critically reviewing the manuscript. All the author (s) read and approved the final manuscript.

Funding

Open access funding provided by Datta Meghe Institute of Higher Education and Research. This research received no external funding.

Data availability

Data supporting the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The study adheres to the Declaration of Helsinki. The study was approved by the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research, Wardha (Approval No.: DMIHER(DU)/IEC/2025/757).

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.