Mini-Residency Exam | Dental Sleep Medicine Training for Dentists

1. What is the anatomy of the upper airway primarily composed of?

A. Heart and Liver
B. Lungs and Diaphragm
C. Nasal Cavity and Trachea
D. Stomach and Intestines

2. Which of the following is a common risk factor for obstructive sleep apnea (OSA)?

A. Low body mass index (BMI)
B. Regular physical exercise
C. Large neck circumference
D. Non-smoking status

3. Which of the following is NOT a type of sleep-related breathing disorder?

A. Obstructive Sleep Apnea (OSA)
B. Central Sleep Apnea (CSA)
C. Insomnia
D. Complex Sleep Apnea Syndrome

4. Which of the following physiological changes occurs during obstructive sleep apnea (OSA) episodes?

A. Decreased heart rate
B. Increased oxygen saturation in the blood
C. Activation of the sympathetic nervous system
D. Relaxation of the upper airway muscles

5. Which type of sleep apnea is commonly characterized by a physical blockage or collapse of the airway during sleep?

A. Obstructive Sleep Apnea
B. Central Sleep Apnea
C. Complex Sleep Apnea
D. Mixed Sleep Apnea

6. What is the primary characteristic of central sleep apnea?

A. Obstruction of the upper airway
B. Absence of respiratory effort
C. Loud snoring
D. Fragmented sleep

7. Which of the following EEG patterns is characteristic of sleep spindles and K complexes?

A. High-frequency, low-amplitude waves
B. Slow, synchronized delta waves
C. Irregular bursts of activity followed by a sharp wave
D. Rapid eye movements with low muscle tone

8. Which of the following are potential side effects of oral appliance therapy?

A. Morning jaw pain that resolves after exercises
B. Persistent jaw pain
C. Muscle tenderness
D. Clicking/Popping
E. Soft tissue and/or tongue irritation/ulcerations
F. Gingival irritation/ulcerations
G. Excessive salivation
H. Dry mouth
I. Changes in occlusal contacts/bite
J. Alterations in positioning of mandibular canines and/or molars
K. Tooth mobility
L. Tooth fractures or damage to dental restorations
M. Appliance fractures/breaks
N. Allergies to appliance material
O. Gagging
P. Anxiety/claustrophobic wearing appliance
Q. Improved taste sensation
R. Enhanced sleep quality

9. Which of the following is a physical consequence of chronic sleep deprivation?

A. Increased risk of cardiovascular diseases
B. Decreased appetite and weight gain
C. Heightened immune function
D. Improved coordination and reflexes

10. What is a common challenge in the adherence to CPAP therapy for sleep apnea treatment?

A. Lack of availability of CPAP machines
B. High cost of CPAP therapy
C. Difficulty adjusting to wearing a mask during sleep
D. Short duration of CPAP therapy sessions

11. Which term describes the condition where a patient experiences both obstructive and central sleep apneas during sleep?

A. Mixed sleep apnea
B. Bi-Phasic sleep apnea
C. Severe sleep apnea
D. Recurrent sleep apnea

12. What is one of the primary functions of sleep?

A. To increase metabolism
B. To enhance physical performance
C. To consolidate memories and learning
D. To decrease heart rate

13. How does the Starling resistor model explain airflow limitation in obstructive sleep apnea (OSA)?

A. It suggests that airway collapse in OSA is primarily caused by excessive mucus production in the upper airway.
B. It proposes that airway collapse occurs due to increased negative intraluminal pressure during inspiration.
C. It describes how dynamic changes in airway pressure and airflow contribute to collapse of the upper airway during sleep.
D. It hypothesizes that airway collapse in OSA results from alterations in the elastic properties of the upper airway soft tissues.

14. Which stage of sleep is characterized by rapid eye movements and vivid dreams?

A. Stage 1
B. Stage 2
C. REM
D. Stage 4

15. Select all the risk factors associated with obstructive sleep apnea (OSA):

A. Obesity
B. Smoking
C. Young age (under 18 years old)
D. Family history of OSA
E. Regular physical exercise
F. Alcohol consumption before bedtime
G. Large neck circumference
H. Post-menopausal status
I. Hypothyroidism
J. Fibromyalgia
K. Acid reflux (GERD)
L. Hypertension
M. Large tonsils
N. High socioeconomic status
O. Low socioeconomic status

16. Which of the following best describes the yaw, pitch, and roll movements of the mandible?

A. Yaw refers to rotation of the mandible around the coronal plane, affecting midline position; roll refers to rotation around the sagittal plane, affecting overall thickness of the device on one side versus another; pitch refers to angular measurement between the maxilla and mandible when viewed from the sagittal plane, affecting overall thickness of the device bilaterally.
B. Yaw refers to rotation of the mandible around the sagittal plane, affecting midline position; roll refers to rotation around the coronal plane, affecting overall thickness of the device on one side versus another; pitch refers to angular measurement between the maxilla and mandible when viewed from the coronal plane, affecting overall thickness of the device bilaterally.
C. Pitch refers to rotation of the mandible around the sagittal plane, affecting midline position; roll refers to rotation around the sagittal plane, affecting thickness of the device on one side versus another; yaw refers to angular measurement between the maxilla and mandible when viewed from the sagittal plane, affecting overall thickness of the device.
D. Roll refers to rotation of the mandible around the sagittal plane, affecting midline position; pitch refers to rotation around the coronal plane, affecting thickness of the device on one side versus another; yaw refers to angular measurement between the maxilla and mandible when viewed from the coronal plane, affecting overall thickness of the device.

17. What must you have prior to initiating oral appliance therapy?
Select all that apply:

A. Dental cleaning within the last six months
B. Diagnostic Sleep Study diagnosed by a board-certified sleep physician within 1-3 years depending on commercial payor
C. Prescription for oral appliance therapy
D. Physician notes to satisfy face-to-face requirement
E. Recent blood pressure measurement
F. Proof of dental insurance coverage

18. What type of signal is typically recorded by electroencephalography (EEG) during sleep testing?

A. Muscle activity
B. Eye movements
C. Brain wave activity
D. Respiratory effort

19. Which of the following characteristics is unique to REM (Rapid Eye Movement) sleep?

A. Decreased heart rate and blood pressure
B. Muscles are relaxed and inactive
C. Vivid dreams occur
D. Brain wave activity resembles wakefulness

20. Which stage of sleep is typically associated with the deepest sleep and the slowest brain wave activity?

A. Stage 1
B. REM sleep
C. Stage 3
D. Stage 2

21. Which of the following is a common risk factor for obstructive sleep apnea (OSA)?

A. Low body mass index (BMI)
B. Regular physical exercise
C. Large neck circumference
D. Non-smoking status

22. Which of the following symptoms is frequently reported by individuals with obstructive sleep apnea (OSA) during the daytime?

A. Excessive daytime sleepiness
B. Reduced appetite
C. Increased energy levels
D. Improved concentration

23. Select all the dental signs commonly associated with a sleep-related breathing disorder:

A. Enamel erosion
B. Bruxism (teeth grinding)
C. Receding gums
D. Malocclusion (misalignment of the teeth)
E. Increased salivation during sleep
F. Crowded or crooked teeth
G. High arched palate
H. Presence of dental caries (cavities)
I. Tongue scalloping (indentations on the lateral edges of the tongue)

24. How do you calculate Total Range of Motion (ROM) in dental measurements?

A. By adding Overbite and Maximum Protrusion.
B. By subtracting Overjet from Maximum Protrusion.
C. By adding Maximum Opening and Overjet.
D. By subtracting Overbite from Maximum Protrusion.

25. What is the primary anatomical factor contributing to the pathophysiology of obstructive sleep apnea (OSA)?

A. Increased activity of the respiratory centers in the brainstem
B. Weakness of the diaphragm muscles
C. Collapse of the upper airway during sleep
D. Dysfunction of the autonomic nervous system

26. On a sleep study, what does the presence of no airflow but continued respiratory effort suggest?

A. Central sleep apnea (CSA)
B. Obstructive sleep apnea (OSA)
C. Mixed sleep apnea
D. Normal sleep pattern

27. What is the primary difference between CPAP, BiPAP, and APAP therapy for treating sleep apnea?

A. CPAP delivers a constant air pressure, BiPAP provides two different pressure levels, and APAP automatically adjusts pressure based on breathing patterns.
B. CPAP and BiPAP are manual therapies, while APAP is a surgical intervention.
C. CPAP and BiPAP are used for central sleep apnea, while APAP is used for obstructive sleep apnea.
D. CPAP and APAP deliver a constant air pressure, while BiPAP automatically adjusts pressure based on breathing patterns.

28. Why is sleep important for overall health and well-being?

A. Sleep allows the body to conserve energy and store excess nutrients.
B. Sleep helps regulate hormones, repair tissues, and strengthen the immune system.
C. Sleep enhances cognitive function only, without impacting physical health.
D. Sleep is not essential for health and can be easily compensated for by caffeine consumption.

29. What is Maximum Protrusion in dental measurements?

A. The percentage of overlap of maxillary anteriors to mandibular anteriors.
B. The horizontal distance between maxillary anterior and mandibular anterior in CR.
C. The maximum stretch of the mandible forward from CR.
D. The distance measured from facial of maxillary anterior to facial of mandibular anterior.

30. In a pull device for oral appliance therapy, where is the maxillary connection point typically located?

A. Anterior to the lower splint connection point
B. Posterior to the lower splint connection point
C. Alongside the lower splint connection point
D. Directly above the lower splint connection point

31. What is circadian rhythm?

A. A type of exercise regimen focused on high-intensity interval training.
B. The natural, internal process that regulates the sleep-wake cycle and repeats roughly every 24 hours.
C. The process of digesting food and converting it into energy in the body.
D. A form of meditation involving deep breathing and mindfulness techniques.

32. Which of the following leads are typically included in a polysomnography (PSG)?

A. Electrocardiography (ECG)
B. Electroencephalography (EEG)
C. Electromyography (EMG)
D. Electrooculography (EOG)
E. Pulse oximetry

33. What is a treatment option for nasal valve collapse?

A. Oral medications targeting nasal congestion
B. Nasal irrigation with saline solution
C. Continuous positive airway pressure (CPAP) therapy
D. External nasal dilators or internal nasal stents

34. What percentage of individuals with obstructive sleep apnea (OSA) remain undiagnosed and untreated?

A. Approximately 20% of individuals
B. Approximately 40% of individuals
C. Approximately 80% of individuals
D. Approximately 100% of individuals

35. In a push device for oral appliance therapy, the maxillary connection point is typically located posterior to the lower splint connection point.

True
False

36. What does Overjet refer to in dental measurements?

A. The percentage of overlap of maxillary anteriors to mandibular anteriors.
B. The horizontal distance between maxillary anteriors and mandibular anteriors in CR.
C. The maximum stretch of the mandible forward from CR.
D. The distance measured from incisal edge of maxillary anteriors to incisal edge of mandibular anteriors.

37. Which of the following leads are commonly used in a home sleep test (HST)?

A. Electroencephalography (EEG)
B. Electrocardiography (ECG)
C. Actigraphy
D. Nasal airflow sensor
E. Respiratory effort belts

38. What is a factor to consider when selecting a device based on the patient’s existing anterior tooth positions?

A. The material used to manufacture the device
B. The presence of posterior occlusal wear
C. The potential directional forces exerted on the anterior teeth
D. The patient's preference for device color

39. Match the Apnea-Hypopnea Index (AHI) number with its corresponding severity diagnosis:
Drag and drop the Sort elements into the correct table cells below.

Sort elements

D. Normal
C. Mild obstructive sleep apnea
B. Moderate obstructive sleep apnea
A. Severe obstructive sleep apnea

4. AHI > 30 events per hour
3. AHI 15 – 29 events per hour
2. AHI 5 – 14 events per hour
1. AHI < 5 events per hour

40. Why is the Oxygen Desaturation Index (ODI) an important measure on a sleep study report?

A. ODI indicates the amount of time spent in different sleep stages.
B. ODI measures the severity of snoring during sleep.
C. ODI assesses the frequency and severity of drops in blood oxygen levels during sleep.
D. ODI determines the effectiveness of medications for sleep disorders.

41. Which of the following statements correctly differentiates between a medical sign and symptom?

A. A sign is a subjective indication of a disease experienced by the patient, while a symptom is an objective observation made by a healthcare provider.
B. A symptom is a measurable characteristic of a disease detected by a healthcare provider, while a sign is a subjective sensation reported by the patient.
C. A sign is an observable manifestation of a disease noted by a healthcare provider, while a symptom is a subjective indication of a disease experienced by the patient.
D. A symptom is an objective finding identified through diagnostic tests, while a sign is a characteristic reported by the patient during a physical examination.

42. What is Overbite, as measured in dental terms?

A. The percentage of overlap of maxillary anteriors to mandibular anteriors.
B. The horizontal distance between maxillary anteriors and mandibular anteriors in CR.
C. The maximum stretch of the mandible forward from CR.
D. The distance measured from facial of maxillary anteriors to facial of mandibular anteriors.

43. Which of the following statements accurately differentiates between the Epworth Sleepiness Scale (ESS) and STOPBANG questionnaire in screening for obstructive sleep apnea (OSA)?

A. The ESS assesses daytime sleepiness, while STOPBANG evaluates risk factors associated with OSA.
B. The ESS focuses on respiratory events during sleep, while STOPBANG measures the frequency of snoring episodes.
C. The ESS evaluates physical characteristics related to OSA, while STOPBANG quantifies sleep quality and duration.
D. The ESS measures oxygen saturation levels during sleep, while STOPBANG identifies the severity of breathing disruptions.

44. How do you determine the vertical position to set an oral appliance starting bite at?

A. By considering the patient's Mallampati score, tongue size, presence of a scalloped tongue, and mandibular tori.
B. By assessing the patient's maximum incisal opening.
C. By evaluating excessive overbite.
D. By determining whether third molars are present and deciding whether to include or exclude them.
E. By ensuring the maintenance of lip seal with the appliance in place.
F. All of the above.

45. What is the relationship between hyoid position and mandibular plane angle in patients with obstructive sleep apnea (OSA)?

A. As the hyoid position moves anteriorly and inferiorly, the mandibular plane angle decreases.
B. As the hyoid position moves anteriorly and inferiorly, the mandibular plane angle increases.
C. As the hyoid position moves posteriorly and superiorly, the mandibular plane angle decreases.
D. There is no significant relationship between hyoid position and mandibular plane angle in patients with OSA.

46. What is the importance of nasal cavity anatomy in relation to obstructive sleep apnea (OSA)?

A. Nasal cavity anatomy has no impact on the severity of OSA.
B. Narrow nasal passages can contribute to nasal congestion but do not affect OSA.
C. Nasal obstruction can lead to mouth breathing, increasing the risk of upper airway collapse during sleep.
D. Enlarged turbinates in the nasal cavity reduce the risk of OSA by improving nasal airflow.

47. Select all the dental conditions commonly associated with obstructive sleep apnea (OSA):

A. Scalloped tongue
B. Excessive overbite/overjet
C. Premolars extracted/crowding (narrow arch)
D. High palatal vault
E. Mandibular Tori
F. Bruxism
G. Abfraction
H. Acid erosion (Reflux/GERD)
I. Dental caries
J. Gingival recession

48. What is Maximum Opening, as defined in dental measurements?

A. The percentage of overlap of maxillary anteriors to mandibular anteriors.
B. The horizontal distance between maxillary anteriors and mandibular anteriors in CR.
C. The maximum stretch of the mandible forward from CR.
D. The distance measured from incisal edge of maxillary anteriors to incisal edge of mandibular anteriors.

49. Deviation in dental mandibular movement is characterized by the mandible moving to one side and returning to its original position, typically associated with a reducing disc displacement or neuromuscular dysfunction.

True
False

50. Deflection in dental mandibular movement involves the mandible shifting to one side and remaining in that position, often associated with non-reducing disc displacement or unilateral muscle restriction.

True
False

51. According to the SARAH index, when comparing oral appliance therapy (OAT) to positive airway pressure (PAP) therapy, which of the following statements is true regarding residual Apnea-Hypopnea Index (AHI)?

A. OAT typically results in a higher residual AHI compared to PAP therapy.
B. PAP therapy generally leads to a higher residual AHI than OAT.
C. Residual AHI is similar between OAT and PAP therapy, indicating comparable effectiveness in reducing sleep disordered breathing events.
D. Residual AHI is not a relevant measure of treatment effectiveness for OAT or PAP therapy.

52. To advance the lower jaw in a pull device for oral appliance therapy, what action is needed?

A. SHORTEN the titration mechanism
B. ELONGATE the titration mechanism

53. Which components are key aspects of Dr. Spooner’s Titration Protocol for oral appliance therapy?

A. Measure total range of motion (ROM).
B. Set the bite of the device at the maximum protrusive position to start.
C. Start titration at a minimum of 50% ROM.
D. Instruct the patient to maintain the initial position for 1 week before adjustments.
E. If the patient experiences pain in the starting position, instruct them to move backward to a comfortable position and start there.
F. The most effective position is generally between 50-80% of ROM.
G. Evaluate subjective symptoms and efficacy at 6 weeks after the patient has been able to adjust the device and determine if further adjustments are necessary.
H. Start titration at a maximum of 10% ROM.
I. The patient should only make adjustments once every two weeks.
J. The most effective position is at the extreme end of the range of motion.

54. How can you determine how much protrusive movement to set an oral appliance starting bite at?

A. By using the phonetic system and finding the position where snore sound resolves.
B. By utilizing the pharyngometer acoustic measurement.
C. By considering the severity of obstructive sleep apnea (OSA).
D. By using the percentage of range of motion (ROM).
E. By relying on the report of patient comfort.
F. All of the above.

55. What is the primary purpose of using an AM repositioner with oral appliance therapy?

A. To monitor the patient's sleep patterns and quality of sleep.
B. To ensure proper alignment of the temporomandibular joint (TMJ) throughout the night.
C. To position the mandible to its pre-treatment position every morning.
D. To measure the effectiveness of the oral appliance in reducing snoring.

56. What is the proper workflow for oral appliance therapy in the dental office?

A. Schedule a separate appointment for screening for a sleep related breathing disorder, obtain diagnostic sleep study from a board-certified sleep physician, identify patient as a good candidate for oral appliance therapy, complete initial exam, deliver oral appliance, 2-week follow-up phone call, 6-week in-office visit, determine if ready for titration studies, set up titration studies, evaluate if further titration needed, have sleep physician interpret "best position" titration study as efficacy study, follow up in 6 months in office, if patient doing well, follow up yearly and send letters to physicians every step of the way.
B. Screening during regular dental exam, refer for screening for a sleep related breathing disorder, obtain diagnostic sleep study from board-certified sleep physician and prescription for oral appliance, identify patient as a good candidate for oral appliance therapy, complete initial exam, oral appliance impressions, deliver oral appliance, 2-week follow-up phone call, 6-week in-office visit, determine if ready for titration studies, set up titration studies, evaluate if further titration needed, have sleep physician interpret "best position" titration study as efficacy study, evaluate if effective and communicate with physician, follow up in 6 months in office, if patient doing well, follow up yearly and send letters to physicians every step of the way.
C. Obtain diagnostic sleep study from board-certified sleep physician and prescription for oral appliance, refer for screening for a sleep related breathing disorder, screening during regular dental exam, identify patient as a good candidate for oral appliance therapy, complete initial exam, oral appliance impressions, deliver oral appliance, 2-week follow-up phone call, 6-week in-office visit, determine if ready for titration studies, set up titration studies, evaluate if further titration needed, have sleep physician interpret "best position" titration study as efficacy study, evaluate if effective and communicate with physician, follow up in 6 months in office, if patient doing well, follow up yearly and send letters to physicians every step of the way.
D. Receive a referral from a physician or a patient calls seeking treatment for sleep apnea. Complete initial exam, identify patient as a good candidate for oral appliance, obtain diagnostic sleep study from board-certified sleep physician and prescription for oral appliance, oral appliance impressions, deliver oral appliance, 2-week follow-up phone call, 6-week in-office visit, determine if ready for titration studies, set up titration studies, evaluate if further titration needed, have sleep physician interpret "best position" titration study as efficacy study, evaluate if effective and communicate with physician, follow up in 6 months in office, if patient doing well, follow up yearly and send letters to physicians every step of the way.

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