"Characterization of Brazilian Dentistry in Dental Sleep Medicine"

Abstract

This study aims to characterize dentists in Brazil who understand and practice Sleep Dentistry (SD), focusing on diagnosing and managing sleep-related breathing disorders (SRBD), such as snoring and obstructive sleep apnea. Our goal is to identify gaps in their training and emphasize the need to integrate dental sleep into the Brazilian system of education. We conducted a descriptive study with 161 Brazilian sleep dentists. Participants answered questionnaires with demographics, educational background, clinical experience, and perspectives on recognizing SD as a specialty. Our findings show that 57.8% of participants graduated from public universities. Many expressed a strong interest in receiving training on SD, highlighting difficulties in effectively managing SRBD. Additionally, they reported the importance of healthcare professionals in improving treatment outcomes for SRBD. This study highlights the need to incorporate sleep health education into dental training programs in Brazil. Aligning these educational improvements with the United Nations in promoting health and well-being, we urge policymakers to formally recognize SD as a key specialty, fostering stronger collaboration between dentists and physicians to enhance patient care and public health.

Keywords

health promotion - sleep medicine specialty - oral medicine - disease prevention - clinical decision-making - health research policy

Introduction

Given the strong association between sleep-related breathing disorders (SRBS) and chronic non-communicable diseases (NCDDs), the role of dental sleep medicine professionals has become increasingly relevant in promoting global health and preventing comorbidities.

The United Nations includes health and well-being as essential elements among the 17 Sustainable Development Goals (SDGs).[1] SDG 3 aims to ensure healthy lives and well-being for all ages, with special attention to NCDs,[2] which account for 80% of deaths in low- and middle-income countries, including cardiovascular diseases, cancer, respiratory diseases, and diabetes.[3] In Brazil, NCDs represent about 72% of deaths, with an increase in deaths from cancer and diabetes in the last decade. In contrast, cardiovascular and chronic respiratory disease mortality rates have decreased.[4] The Strategic Action Plan for Addressing NCDs 2021-2030 focuses on preventing risk factors and reducing inequalities.[4]

SRBD, such as obstructive sleep apnea (OSA) and hypoventilation, are crucial categories in the International Classification of Sleep Disorders.[5] OSA affects approximately one billion adults worldwide, posing a significant public health concern. The growing prevalence of obesity, a major risk factor for OSA, now affects almost two billion adults, while the aging population further increases this vulnerability.[6] Untreated OSA is associated with severe comorbidities, such as cardiovascular diseases and high mortality, representing threats to both individual and collective health.[7] [8] [9] The economic impact of OSA affects productivity and public safety, demanding improved management strategies.[6] The high prevalence and significant treatment costs for OSA,[6] [8] [10] [11] as well as its impact on conditions such as hypertension and diabetes, underscore the need for effective management.[10] [12] [13] Adopting a proactive approach is essential; this includes early identification and intervention, fostering a cooperative team, and implementing public health programs to reduce risk factors such as obesity and hypertension.[12] [14] Although complete prevention of OSA may not always be feasible, appropriate strategies can mitigate the risk of its occurrence and worsening.[9] [11]

Sleep Dentistry (SD) focuses on the management of specific SRBD that fall within the dental scope of practice, namely primary snoring, OSA, and Upper Airway Resistance Syndrome (UARS). It integrates with interdisciplinary teams to provide more comprehensive care.[5] [15] [16] [17] [18] [19] [20] [21] [22] [23] While a study shows a reduction in central apnea events with a Mandibular Advancement Devices (MADs),[24] the article indicates that the patient did not have a predominance of central apnea, but rather a reduction in the number of central events. Therefore, the scope of the dentist's practices remains limited to snoring, UARS, and OSA.[25] The diagnosis and medical management of these disorders, such as central sleep apnea or hypoventilation syndromes,[24] [26] [27] must be carried out in collaboration with and under the guidance of a sleep physician. This interdisciplinary approach supports early detection and targeted treatment, helping to reduce the morbidity and mortality associated with SRBD and other NCDs.[16]

Including SD in public policies, especially in the Unified Health System, may bring substantial benefits to patient health while reducing long-term costs and improving quality of life, promoting the sustainability of the health system.[6] [10] [11] [28] Furthermore, SD has a multifaceted role that encompasses diagnosis and treatment, utilizing MADs for mild to moderate and severe apnea in cases where the patient does not adhere to CPAP (continuous positive airway pressure)[29] [30] as well as education on oral and sleep health, emphasizing the importance of an interdisciplinary approach focused on prevention and the promotion of healthy habits.[31]

Sleep Medicine has advanced, with CPAP being an effective treatment for OSA.[32] However, low adherence to CPAP presents a challenge.[33] SD emerges as an effective alternative, offering intraoral devices, such as MADs, for patients who do not tolerate CPAP.[29] [30] [34] This personalized approach enhances satisfaction and potentially increases treatment adherence.

Some authors emphasize that professionals treating OSA should have adequate qualifications, including certification in sleep medicine from a non-profit entity.[29] [30] Standardizing training and practice would help reduce healthcare system costs and improve patients' quality of life, benefiting public health.[6] [8] [10] [35] [36] Strengthening the role of SD in this field highlights the need for a specialty in SD.[15] [16] [18] [23]

The primary research question guiding this study is: What is the current state of knowledge and practices among SD in Brazil regarding diagnosing and managing OSA?

In line with findings from international literature,[15] [16] [17] [18] [19] [20] [21] this research highlights the need for better dental education on OSA management and encourages collaboration to improve patient health outcomes.

The study aims to characterize the profile of dentists working in SD in Brazil, evaluate adopted clinical practices, identify challenges such as lack of patient knowledge and the need for regulation, and explore dentists' perceptions of SD as a recognized specialty. Through this research, we aim to provide insights that promote specialized training and improve care for patients with SRBD, guiding authorities in implementing health and well-being policies, particularly in preventing and treating NCDs.[3]

Materials and Methods

The exploratory, descriptive study received ethical approval from the Research Ethics Committee of the State University of Campinas (UNICAMP) on February 29, 2024, under CAAE: 76218023.1.0000.5404. All participants provided signed Informed Consent Forms (ICF).

The research was conducted in various regions of Brazil, covering the entire national territory. The target population consisted of dentists who worked in the field of SD ([Fig. 1]). Due to a lack of accurate information regarding the population of professionals engaged in SD, we estimated a population of approximately 600 professionals, and based on sample calculations, we determined a sample size of 385 professionals to ensure representative results, with a margin of error of 3% and a confidence level of 95%. The minimum sample size was 235 professionals, with a margin of error of 5% and a confidence level of 95%. Thus, following the best practices recommended by the American Statistical Association,[37] we calculated the sample size prior to data collection, setting a 5% margin of error and a 95% confidence level. Over time, however, there was a decline in participation, leading us to halt data collection before reaching the originally planned minimum sample size. The data was becoming outdated and no longer reflected the current reality. Therefore, although we acknowledge that our final sample does not meet the initial 5% margin of error or 95% confidence level, and considering these limitations, we focused the study on 161 participants. This decision was based on our belief that post hoc sample size calculations are not reliable. Additionally, our sample size lies between those used in two studies: one from the US[16] and another from the UK,[18] with 311 and 139, respectively.

Fig. 1 Research Diagram.

Participants were restricted and directed toward the study's objectives, covering different regions of Brazil. We chose from SD study groups on WhatsApp and the Brazilian Sleep Academy.

The inclusion criteria encompassed dentists who develop SD activities and have experience treating snoring, OSA, and bruxism. The exclusion criteria included questionnaires answered outside the 13 weeks, lack of informed consent, and professionals not working in the field.

We collected data through structured questionnaires created in Microsoft Forms and the ICF, accessed via a link sent by the Brazilian Sleep Academy, and in study groups via WhatsApp, ensuring broad and representative reach.

We divided the questionnaires into topics covering various aspects of SD, including current involvement in the field, demographic location, training, and interest in SD, prosthetic and dental documentation laboratories, research, development, innovation, and final considerations. We aimed to address the Brazilian reality, ensuring clarity and relevance to the research. The estimated time to complete the survey was approximately 12 minutes.

A structured questionnaire measured the variables, covering different aspects relevant to the research.

We transferred the collected data to Excel software and then to the SAS system, where we-analyzed it using descriptive statistics and created indicators.

The analysis combined qualitative and quantitative elements, providing a comprehensive understanding of the practices and perceptions of health professionals involved in SD in Brazil.

Results

The study involved 161 Brazilian dentists ([Fig. 2]) with signed IC Forms and completed questionnaires. Most participants worked autonomously, reflecting the reality of the Brazilian dental market.

Fig. 2 Representation of the Brazilian regions that participated in the survey and the completion period.

In [Table 1], we indicate the demographic data of the survey participants using frequency, percentage, and chi-square statistics (x² ).

Table 1 Frequency (percentage) of the sociodemographic characteristics studied and chi-square statistic (x2) for the hypothesis of equality of proportions

Characteristics	Frequency (%)	Chi-square statistic
Gender identity
Cis man	42 (26.09)	x2 :36.83 Valor-p: 0.0001
Cis woman	119 (73.91)
Marital status
Married	117 (72.67)	x2 :283.19 Valor-p: 0.0001
Divorced	12 (7.45)
Separated	3 (1.86)
Single	19 (11.80)
Stable Union	10 (6.21)
Age at graduation (years)
19 o-| 21	20 (13.89)	x2 :149.72 Valor-p: 0.0001
21 o-| 24	99 (68.75)
24 o-| 28	18 (12.50)
28 o-| 31	7 (4.86)
Age at response (years)
25 o-| 31	4 (2.76)	x2 : 69.45 Valor-p: 0.0001
36 o-| 40	12 (8.28)
40 o-| 50	43 (29.66)
50 o-| 60	59 (40.69)
60 o-| 73	27 (18.62)
Time since graduation (years)
2 o-| 8	6 (3.73)	x2 :64.25 Valor-p: 0.0001
12 o-| 20	24 (14.91)
20 o-| 30	54 (33.54)
30 o-| 40	58 (36.02)
40 o-| 48	19 (11.80)
Year of graduation
<= 1986	37 (22.98)	x2 :38.22 Valor-p: 0.0001
1986 o-| 1990	23 (14.29)
1990 o-| 2000	52 (32.30)
2000 o-| 2010	42 (26.09)
2010 o-| 2021	7 (4.35)
HEI administrative sphere
Community	1 (0.62)	x2 :118.47 Valor-p: 0.0001
State	30 (18.63)
Federal	60 (37.27)
Municipal	3 (1.86)
Private	67 (41.61)
HEI nature
University center	15 (9.32)	x2 : 106.59 Valor-p: 0.0001
University	146 (90.68)
Certification by ABS
No	110 (68.32)	x2 :21.62 Valor-p: 0.0001
Yes	51 (31.68)

Abbreviations: BSA, Brazilian Sleep Academy; HES, Higher Education Institution.

[Table 1]. Frequency (percentage) of the sociodemographic characteristics studied and chi-square statistic (x² ) for the hypothesis of equality of proportions.

Among the demographic characteristics analyzed, we found that most Brazilian dentists working as SD are women (73%). Most are not certified by the Brazilian Sleep Academy ([Tab. 1]). The most mentioned sources of professional updating ([Tab. 2]) included in-person courses, online courses, conferences, congresses, scientific publications, and study groups.

Table 2 Frequency and percentage of levels of complementary training in SD for professionals with and without certification in SD and maximum likelihood ratio test (G² ) for the hypothesis of association between the factors under study

Complementary training in SD	Certification in SD by BSA		Total
	No	Yes
Improvement – G2 : 0.73; p-value: 0.3926
No	46 (64.79)	25 (35.21)	71
Yes	64 (71.11)	26 (28..89)	90
Update – G2 : 0.71; p-value: 0.3999
No	46 (64.79)	25 (35.21)	71
Yes	64 (71..11)	26 (28..89)	90
Course load greater than 180 hours/class – G2 :12.27; p-value: 0.0005
No	55 (83.33)	11 (16.67)	66
Yes	55 (57.89)	40 (42.11)	95

Abbreviations: BSA, Brazilian Sleep Academy; SD, Sleep Dentistry.

[Table 2]. Frequency and percentage of levels of complementary training in SD for professionals with and without certification in SD and maximum likelihood ratio test (G² ) for the hypothesis of association between the factors under study.

Regarding the scientific activity of these professionals ([Tab. 3]), regardless of whether the dentists are certified by the Brazilian Sleep Academy, approximately 52 professionals have acted as researchers in the field of sleep, with 33 being active researchers and approximately 43 having scientific publications. Only 6 participants were authors of books, and 22 contributed chapters to books related to the field. Regarding ownership of patents related to SD, only 11 participants stated they owned them.

Table 3 Frequency and percentage of characteristics related to the scientific activity of professionals with and without certification in SD and maximum likelihood ratio test (G2) for the hypothesis of association between the factors under study

Scientific activity	Certification in SD by BSA		Total
	Não	Sim
Has worked as a researcher – G2 : 14.13; p-value: 0.0002
No	85 (77.98)	24 (22.02)	109
Yes	25 (48.08)	27 (51.92)	52
Currently engaged in research – G2 : 2.14; p-value: 0.1437
No	91 (71.09)	37 (28.91)	128
Yes	19 (57.58)	14 (42.42)	33
Nature of research institution – G2 : 6.71; p-value: 0.0348
Federal University	5 (31.25)	11 (68.75)	16
State University	4 (66.67)	2 (33.33)	6
Others	8 (80.00)	8 (20.00)	10
Published scientific article – G2 : 15.10; p-value: 0.0001
No	91 (77.12)	27 (22.88)	118
Yes	19 (44.19)	24 (55.81)	43
Author of book(s) – G2 : 0.90; p-value: 0.3424
No	107 (69.03)	48 (30.97)	155
Yes	3 (50.00)	3 (50.00)	6
Author of book(s) chapter(s) – G2 : 14.52; p-value: 0.0001
No	103 (74.10)	36 (25.90)	139
Yes	7 (31.82)	15 (68.18)	22
Others	6 (85.71)	1 (14.29)	7
Author of patent – G2 : 0.9798; p-value: 0.3222
No	104 (69.33)	46 (30.67)	150
Yes	6 (54.55)	5 (45.45)	11

Abbreviations: BSA, Brazilian Sleep Academy; SD, Sleep Dentistry.

[Table 3]. Frequency and percentage of characteristics related to the scientific activity of professionals with and without certification in SD and maximum likelihood ratio test (G2) for the hypothesis of association between the factors under study.

Most respondents (89.44%) used sleep laboratories for patient diagnosis, with 59% having Type IV polysomnography equipment. In addition to these diagnostic and monitoring exams, 96.27% of dental professionals reported using dental documentation exams, such as cephalometric radiographs and panoramic X-rays, for complementary diagnoses. In comparison, only 13.66% used computer tomography, scans, and 3D-printed models.

In this study, 96.27% of participants used prosthetic laboratories, with 49% utilizing analog workflows, 19.88% employing digital workflows, and 48.45% following mixed workflows.

The demand for sleep disorder services increased, with 144 (89.44%) of the dental professionals interviewed indicating so. The age range of the patients treated is predominantly adults (75.78%), with a relatively small frequency of treatment for children under 12 years old (1.86%).

The dental professionals reported that the main difficulties included a lack of patient knowledge about the disease, financial limitations, patient cooperation during treatment, and challenges in diagnosing and assessing sleep disorders. The primary treatment offered in daily practice was using individualized oral appliances.

When researchers asked participants about the specialty names, 82 dental professionals indicated SD as the specialty name, while 72 stated Dental Sleep Medicine.

[Table 4] provides an overview of the main comments about sleep disorders, highlighting the specialty's importance, the need for its inclusion in undergraduate courses, and the role of dental professionals in promoting public health. Sleep physicians and dental professionals considered the interaction between their fields essential, along with the need for public policies that recognize and integrate sleep disorders into the health system.

Table 4 Comprehensive overview of the main comments from the report on Sleep Dentistry

Item Description	Item Description
Recognition of the Specialty	Importance of SD' specialty recognition by the Federal Council of Dentistry
Name of the Specialty	Sleep Dentistry.
Regulation and Training	Call for regulation and inclusion of content in the curriculum.
Certification and Courses	Demand for regulation and adequate training in the area.
Importance of the Specialty	Area of activity that has come to add value to Sleep Medicine.
Information and Education	DS formation about sleep disorder diagnoses and treatment for professionals and the general population.
Documentation Centers	Service widely used for complementary diagnostics.
Improvement in Treatment	Lack of adherence to cooperation and knowledge about SD.
Treatment Safety	Need for regulation and adequate training for professionals and multidisciplinary teams.

[Table 4]. Comprehensive overview of the main comments from the report on SD

Discussion

SD represents a critical intersection between dentistry and sleep health, underscoring the vital role of dental practitioners in screening and managing SRBD, such as snoring, UARS, and OSA, while collaborating with sleep physicians in cases involving central apneas or other medically complex conditions.[24] [26] [27]

Recognizing the relevance of OSA management,[5] [15] especially its association with cardiovascular diseases[7] [8] [9] and its financial impact on public health systems,[12] [13] our study presents an overview of the profile of dentists working in sleep medicine in Brazil since 1998, when the Instituto do Sono began offering training courses, including those in Odontology. We highlight their demographic characteristics, professional experiences, and main challenges.

Characterization of the Professionals' Profile

In general, sleep medicine has established itself as a necessary discipline to meet growing demands related to sleep disorders. In several countries, the inclusion of sleep medicine in academic training is still in its early stages; in Germany and France, for example, sleep medicine is integrated into undergraduate curricula in a limited way.[19] [20]

The increasing participation of women in the dental field is notable in the United States and Canada[17] and particularly pronounced in urban areas of Europe, such as Italy.[21] Our study provides statistical data on the predominantly female participation in SD. In Brazil, dentists working in sleep medicine are primarily concentrated in the Southeast region, particularly in São Paulo and Rio de Janeiro.[38] Women represent 73% of this practice, which aligns with the national figure of 60.1% of all registered female dentists.[39] This shift reflects a professional global trend with regional variations.[40]

Additionally, the high rate of postgraduate education among dentists working in sleep medicine (99%) demonstrates a search for differentiation in a saturated market, aligning with global trends that associate advanced education with excellent clinical practices and greater competitiveness.[6] [33] [41] However, many practitioners identify sleep medicine only after graduation, highlighting a significant gap in their initial training. Countries like Germany[19] and China[22] have yet to fully integrate sleep medicine into their curricula, which leads to clinical insecurity among practitioners. In the UK, 76% of dentists actively choose to refer cases to specialists instead of managing them themselves.[18]

In Brazil, SD has undergone significant advancements in the past two decades, including the establishment of professional certification. The Brazilian Sleep Association (Associação Brasileira do Sono – ABS) has offered a formal certification for dentists in sleep medicine since 2011, which requires rigorous theoretical and clinical training, ensuring that certified professionals possess in-depth knowledge and skills to provide evidence-based care. In addition, the 2024 Brazilian Consensus on Sleep Medicine[25]-was officially presented during the SONO 2024 Meeting, marking a milestone in the standardization of practices within the field. This consensus outlines clinical guidelines, scope of practice, and interprofessional collaboration pathways, reinforcing the importance of a unified and scientifically grounded approach to the management of SRBD in the country. We observed in our research that most dentists currently working in DS medicine in Brazil still have less than 15 years of experience. Despite the existence of a formal certification process by the Brazilian Sleep Association (ABS), most professionals in the field have not yet obtained this credential. This, combined with disparities in clinical workload and training, highlights the urgent need for the implementation and dissemination of standardized criteria, such as those required by the American Board of Dental Sleep Medicine in the USA.[42] The presentation of a national consensus at the SONO 2024 Meeting represented an important step toward regulation and interdisciplinary integration. These findings underline the importance of integrating sleep medicine into undergraduate and postgraduate dental curricula, as well as promoting standardization in training and certification, to reinforce clinical practice and expand access to sleep disorders treatments in Brazil. We emphasize that inadequate training in sleep medicine can compromise diagnostic accuracy and treatment efficacy, with direct consequences for patient care.

Clinical Practices

Sleep quality for health and well-being is fundamental in preventing NCDs,[1] [2] and it is responsible for the high mortality rate in Brazil among low- and middle-income nations. As our work highlights the United Nations related to health and well-being,[43] the authors indicate that sleep health should be a priority integrated into public health policies. Education programs and awareness campaigns can transform public perception of the importance of sleep, contributing to the prevention of NCDs such as cardiovascular diseases and diabetes. Furthermore, these initiatives must be inclusive, addressing the needs of vulnerable groups so that we can align sleep health strategies with the Sustainable Development Goals, fostering a healthier and fairer future for all.

The SD already has guidelines and recommendations for dentists to develop specific skills, including interpreting sleep study results, such as polysomnography, and integrating this information into clinical practice.[29] [30] Additionally, a comprehensive meta-analysis conducted in 2015[44] evaluated the effectiveness of MADs in treating OSA, including 17 studies with different trial designs, highlighting how MADs have emerged as an increasingly viable therapeutic option.[29] [30] The authors mentioned that MADs significantly reduced the apnea-hypopnea index and improved sleep quality, although they classified the quality of evidence as low. This study also showed that the effectiveness of MADs in managing OSA depends on the appropriate choice of device and the professional's competence in customizing the treatment for each patient. Our study underscores the importance of professional updating with the latest research and guidelines to provide the best patient care, keeping SD informed and up to date in their clinical practices.

Our study reveals that most dentists in SD graduated from public universities (57.8%) or private universities (41.6%) and practice as independent practitioners in their clinics. Certified professionals from the Brazilian Sleep Academy more frequently participate in courses and congresses, suggesting that they are more engaged and better prepared, which can impact the quality of care.

MADs are widely used by certified and non-certified dentists, highlighting their recognized effectiveness.[45] However, this also raises questions about the need for standardization and regulation to ensure safety and efficacy in treatment. Most patients treated are adults and elderly, with a higher prevalence of OSA,[9] [11] [14] [46] emphasizing the importance of training dentists to cater to this growing population. We aim to provide a secure and confident environment for practitioners and patients by advocating for standardization and regulation.

Similarly to the present study, research conducted in the UK[18] observed an increase in the demand for identifying and treating intraoral appliances, which spurred greater interest among SD in offering these devices. Researchers attributed this increase to the growing public and professional awareness of sleep disorders,[16] [46] with numerous professionals expressing interest in further training.[47] By acknowledging the role of public and professional awareness, we can all feel engaged and responsible in advancing SD.

In the current study, 90% of the participants used prosthetic laboratories, which are crucial for fabricating MADs. Among these, 49% used an analog workflow, 31% used a digital workflow, and 20% used a mixed workflow. Although they do not yet represent the majority, there is a trend toward adopting digital technologies in MADs fabrication. The transition to digital technologies in creating MADs can improve the accuracy and efficiency of treatments.[48]

Challenges and Needs

We observe that the dentists involved in SD encounter various obstacles, such as patients' lack of information about sleep disorders, difficulties in diagnosing and treating, financial constraints, and low patient collaboration, as indicated in previous research.[49] Additionally, the authors emphasized that evaluation and diagnosis should be carried out by physicians, preferably specialists in sleep medicine, due to the complexity of the condition and the need to consider medical comorbidities. These challenges are not unique to Brazil but are also common in other countries. Addressing these challenges and needs is crucial for effectively integrating SD into healthcare systems.

Research on the cost-effectiveness of intraoral devices compared to other interventions for sleep apnea and snoring could justify their funding and inclusion in healthcare systems.[47]

Integrating SD into public and private services, mainly through the collaboration of multidisciplinary teams, deepens their involvement in sleep medicine, especially given the intricate complexities of sleep disorders and their comorbidities. SD can potentially enhance diagnosis and treatment,[15] [16] [17] [18] [19] [20] [21] [22] [23] especially for the elderly population, who are more susceptible to these disorders.

Moreover, in 2023, some researchers highlighted[43] a collaborative and multidisciplinary approach to sleep health, promoting education and awareness across various health fields. Including different specialties, as our study supports SD, expanding programs like "Brasil Sorridente"[28] in public health can promote more equitable access to treatments, improve user experience, and reduce costs,[6] [8] [10] associated with preventable complications. Investigating the perception and understanding of patients using intraoral devices, including treatment adherence and quality of life, can provide valuable insights to enhance the acceptance and use of these devices.[47] This integrated approach would not only benefit patients but also contribute to the formation of a more effective and comprehensive care network,[30] [32] as the lack of patient knowledge about sleep disorders,[16] difficulties in diagnosis, and low patient cooperation are obstacles observed not only in Brazil but also in other countries.

The recommendation to work in SD is for dentists to develop specific skills. These skills include interpreting sleep study results, such as polysomnography, and integrating this information into their clinical practice.[29] Polysomnography is crucial in diagnosing sleep disorders.[25] Satisfactorily, our research shows that over 90% of professionals use sleep laboratories for diagnosis, and 59% conduct type IV polysomnography. This helpful alternative does not replace type I or II polysomnography exams, which are essential for more detailed assessments of sleep disorders. With the growing demand for diagnosis, the Unified Health System needs to expand sleep laboratories.

Perception on Regulation

The formal recognition of the specialty in undergraduate courses and its integration into public health policies are essential to ensure equitable access to quality care for the population. Creating a specialty in SD is essential for effectively treating SRBD, such as OSA, as it requires specific knowledge of airway anatomy, sleep physiology, and its relation to overall and oral health. Qualified professionals are fundamental for managing devices such as MADs,[15] [29] an alternative to CPAP, widely recognized as a primary treatment for mild and moderate OSA. The specialty in SD highlights the need for public policies integrating SD into the health system.

Brazilian Sleep Academy was founded in 1985 and brings together professionals from various fields in a multidisciplinary model, including dentists and doctors. Since 2005, a movement has been to recognize SD as a formal specialty, supported by the Brazilian Sleep Academy and the Brazilian Association of Sleep Odontology. At the World Sleep Congress in 2023, held in Rio de Janeiro, participants discussed the standardization of teaching and certification in sleep medicine, which promotes interdisciplinary collaboration. SD effectively diagnoses and treats disorders such as snoring and OSA[50] [51] but faces challenges in fully integrating into health teams.[52] [53] [54] Formalizing SD supports SDG 3 (Sustainable Development Goal 3) related to health and well-being. It helps to treat conditions such as hypertension and diabetes associated with SRBD, which can improve early diagnosis and reduce mortality.

Recommendations for Training and Capacity Building

The current study highlights a growing interest among dentists in enhancing their knowledge of SD, a trend also observed in other countries, indicating a need for more training to improve clinical practice and patient care.[16] [47] The lack of knowledge about SRBD suggests the necessity of incorporating this topic into undergraduate curricula and continuing education courses.[16] [18]

Understanding sleep medicine and various sleep disorders is vital for distinguishing these conditions from OSA,[55] as well as for effective treatment. Expanding sleep medicine content in dental education is essential despite requiring additional time and coursework.[16] The research underscores the urgency of including this subject in dental curricula,[10] fostering a multidisciplinary approach that enhances oral and patient health.[15] [16] [17] [18] [19] [20] [21] [22] [23] Training future dentists through "Teaching the Teacher" initiatives and integrating SD knowledge into undergraduate programs is crucial for effectively diagnosing and treating patients with SRBD.[19]

Contextualizing Health Policies

Sleep is crucial for physical and mental well-being, impacting performance, immunity, and cognitive development,[56] with disorders like OSA posing serious health risks.[8] SD facilitates the diagnosis and treatment of these disorders,[57] where dentists play a vital role through various therapeutic approaches.[52] However, a lack of in-depth knowledge about OSA can hinder patient care. Treating OSA requires interdisciplinary expertise,[15] aligning with health and well-being to promote comprehensive health and equal access[1] while strengthening partnerships among dentistry, medicine, and public health professionals. This collaborative approach enhances health systems and improves access to diagnosis and treatment, underscoring the need for a team-based strategy in addressing OSA.

Limitations

This study is the first in Brazil to characterize SD working with SRBD. However, it has some limitations, such as a restricted sample of dentists, which may not adequately represent Brazil's total population of professionals. We used questionnaires that rely on participants' self-reports, which can lead to biased or inaccurate responses. Researchers should consider these limitations when interpreting the study's results and planning future research.[23]

Relevance

• Role of SD: Essential in managing sleep disorders, improving health, and aligning with the United Nations.

• Overview in Brazil: There is a need for integrated and qualified action from dentists to enhance sleep health.

• Urgent Recognition: SD must be officially recognized to ensure training and teamwork.

• Public Policies: Addressing gaps in training and prioritizing sleep health are essential for a healthy future.

Conclusion

Our study highlights the importance of training specialized professionals in SD in Brazil and their integration with multidisciplinary. Despite the engagement of professionals working in SD, significant impact gaps exist, such as a lack of professional recognition and patients' lack of awareness. Aligned with the validation of this specialty meets SDG 3, which aims to promote health and well-being by enhancing training and improving the quality of care. By identifying and addressing existing gaps and implementing effective public policies in our Unified Health System, we can ensure a healthier and more sustainable future for the Brazilian population.

Conflict of Interest

None.

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Publication History

Received: 17 February 2025

Accepted: 16 October 2025

Article published online:
31 December 2025