Alan D. Steljes, MD, FACC, FRCP

Tell us about yourself.

I started my first sleep lab in 2010 in my cardiology office. A sleep lab was definitely unusual for a cardiologist in those days. Sleep medicine was more commonly associated with pulmonology or ENT. Maybe neurology, but never cardiology!

I had several requirements for the new program, which were not available within the community at that time: First, to provide a safe lab for complex patients with cardiovascular disorders. Second, to follow-up on patients post diagnosis to optimize results of therapy. And finally, to offer patients options for therapy.

As much as I appreciate the benefits of CPAP, it was not acceptable to offer CPAP as a one-size-fits-all therapy. Instead, every patient is counseled that there are 3 options for therapy – CPAP, an oral appliance (OAT), or surgery. We discuss the pros and cons of each option, specific to that patient. Often, we recommend CPAP as the first choice and OAT as the backup. Sometimes the other way around. Either way, the patients are always aware that there is a backup option.

With your background as a cardiologist, how did you learn so much about how dentists work in their clinic?

Finding a dentist to fit the oral appliance was a challenge. Many dentists were willing but it became apparent that few had the requisite experience. Insurance was also an obstacle. Most of our patients have Medicare which would cover the device. Most dentists don’t take Medicare. (Can’t blame them!)

That’s when Dr. Pam West introduced herself to our practice. She is an experienced dentist with a solid training and extensive clinical experience. She had dedicated the majority of her practice to treating sleep apnea patients. Just as important, she had the passion for sleep that comes when you realize how therapy impacts people’s lives.

It was exciting to view sleep apnea from her perspective. I gained a better understanding of the interface of mandible, maxilla, and tongue.

How do you see the future of dentist-physician collaboration going as communications improve?

We have added other dental practices as our coverage has spread across the Las Vegas Valley. Our relationships are mutually beneficial and are founded on respect and trust. We refer patients who have tried and failed on CPAP, or who have declined CPAP. The dentists, in turn, refer patients to us for sleep management. Typically, these are patients who have been identified as high risk for sleep apnea or are patients with a positive home sleep apnea test (HSAT.) If OSA is mild to moderate, we return the patient to the dentist for OAT. Our only request is that the patient has a follow-up HSAT on the device after optimizing therapy. HSAT may be performed either by us or by the dentist.

Technology is evolving in dental sleep, and multiple devices are now available. We respect the dentist as the specialist. The dentist can choose whichever modality he/she feels is the best for that patient.