Obstructive Sleep Apnea (OSA) is a very serious condition that can even be life-threatening, if the case is severe enough. OSA causes disrupted sleep and low blood oxygen levels in patients.
During sleep, the patient’s upper airway can be obstructed by the tongue getting sucked to the back of the throat, excess tissue, or large tonsils. It can cause airflow to stop entirely. When the oxygen level in the brain gets too low, the apnea occurs and initiates enough brain impulses for the patient to partially wake and clear the obstruction, usually with a gasp as air starts flowing again. Sleep apnea is defined as the presence of 30 or more apneas during a seven-hour sleep. In severe cases it can happen up to 500 times in a night.
If the deoxygenation cycle repeats often enough, it can lead to serious cardiovascular issues as well as excessive daytime sleepiness, depression, and an inability to concentrate. There’s also a less severe obstruction called Upper Airway Resistance Syndrome (UARS), which causes many of the same symptoms.
Treatment starts with recognition that you have the symptoms of OSA and then getting a consultation. Our oral and maxillofacial surgeons can offer consultation and treatment options for you, depending on the severity of your condition.
We’ll assess your condition, and can determine the severity of obstruction through a cephalometric (skull x-ray) analysis. If necessary, we can also perform a naso-pharyngeal exam with a flexible fiber-optic camera. It’s common to have patients be monitored overnight for a sleep study so that we can monitor the number of apneas that occur, and how long they are.
There are multiple treatment options available to you that can be very effective. A common treatment is the use of a nasal CPAP machine that delivers pressurized oxygen through a nasal mask while you sleep. There are surgical options, including a uvulo-palato-pharyngo-plasty which is performed in the back of the soft palette and the throat. This procedure can also be done with the assistance of a laser. In certain cases, we can perform a radio-frequency probe to tighten the soft palate. Most of these procedures will involve light IV sedation in the office.
The most complex treatments involve repositioning the bones of the upper and lower jaw to increase the size of the airway to allow more airflow. This orthognathic surgery is done in the hospital under general anesthesia, and will require staying one or two nights in the hospital. It’s important to remember that no surgical procedure is universally successful, and treatment might depend on the specific shape of your nose and throat.
Oral appliance therapy has proven to be an effective treatment option to help OSA related issues. A custom fit oral sleep appliance can provide many benefits, including improved sleep and alertness. These appliances are only worn during sleep. The appliance fits like a mouth guard, supporting the jaw in the forward position to help maintain an open airway. These appliances are:
Many sleep apnea dental appliances do come with drawbacks however:
Oral and maxillofacial surgeons receive extensive training during their residencies in jaw advancement surgery and techniques, as well as in the medical and perioperative surgical management of these patients. The AAOMS advocates for routine OMS involvement and participation on the sleep apnea treatment team, and supports the development of multidisciplinary comparative effectiveness trials for management of the OSA patient.
OSA can be a very serious condition that should be treated sooner rather than later. Coverage of OSA is common under major medical plans. Call us if you have any questions. We’ll be glad to answer any questions you might have and discuss your treatment options with you.