Sleep Apnea

People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue is sucked against the back of the throat. This blocks the upper airway and airflow stops. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp.

Repeated cycles of decreased oxygenation lead to very serious cardiovascular problems. Additionally, these individuals suffer from excessive daytime sleepiness, depression, and loss of concentration.

Some patients have obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, the individuals suffer many of the same symptoms.

The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons offer consultation and treatment options.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With 3D cone beam CT  or cephelometric X-ray analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera.

There are several surgical and non-surgical treatment options available that requires the coordination of multiple specialties.

Non-Surgical Therapies:

Sleep Medicine Specialist: Some neurologists specialize in sleep medicine. To confirm sleep apnea severity and the amount of cardiovascular compromise, a neurologist may recommend a sleep study to monitor an individual overnight. Based upon the findings of the sleep study an initial treatment may consist of using a nasal CPAP (Continuous Positive Airway Pressure) machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. CPAP will cure sleep apnea as long as a patient is able to tolerate their CPAP machine and reliably wear the device while sleeping. The neurologist may also recommended weight loss,  a change of diet, and increased exercise.

Dentist or Orthodontist:   If a patient is unable to tolerate CPAP or if they would like to pursue a different non-surgical option the sleep specialist may recommend that your dentist or orthodontist make a sleeping appliance. The sleeping appliance is made from an impression of your teeth and is worn like a mouth guard. It is designed to position the lower jaw forward while you sleep, this corrects sleep apnea by increasing the size of the airway.

Surgical Therapies:

Otolaryngologist (ENT): If non-surgical therapies are unsuccessful your neurologist or dentist may recommend an evaluation my a surgeon. If the sleep apnea is caused by an obstruction in the nose or palate (back of the throat), you may be sent to an ENT surgeon. Following an exam the surgeon may recommend uvulo-palato-pharyngo-plasty (UPPP), laser assisted uvulo-palato-plasty (LAUPP), tonsillectomy, adenoidectomy, septoplasty or turbinectomy. The UPPP and LAUPP are similar procedures performed in the back of the soft palate and throat to eliminate excess tissue and tighten the palate. Tonsillectomy and adenoidectomy is most frequently done in younger patients with large tonsils and adenoids that cause airway obstruction. The removal of these structures can cure sleep apnea by opening the airway. Septoplasty and turbinectomy are performed if the sleep apnea is caused by an obstruction in the nose. These procedures are done to open and straighten the nasal airway so less effort is required to breath through the nose.

Oral and Maxillofacial Surgeon: In more complex cases, orthognathic surgery (jaw surgery) may be required to cure sleep apnea. Orthognathic surgery is the most effective surgery for curing sleep apnea caused by an obstruction at the level of tongue and throat. Orthognathic surgery repositions the bones of the upper and lower jaw to increase the size of the airway and relieve the obstruction. This procedure is done in the hospital under general anesthesia and requires a one or two-night stay in the hospital.

OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.