What is Obstructive Sleep Apnea?
Obstructive sleep apnea (OSA) is a disorder characterized by breathing interruptions while sleeping and low blood oxygen levels. Sleep apnea occurs when some portion of the upper airway becomes blocked . As the blood oxygen level in the brain becomes low, the sleeper will usually wake up with a gasp, in order to clear the blocked airway. Approximately 1 in 5 adults are affected by mild OSA and 1 in 15 have at least moderate OSA. This disorder can also effect as many as 3% of children.
Other medical conditions can cause breathing problems during sleep. Sometime, OSA is present with these other disorders and may compound the breathing problems at night. The expertise of your oral and maxillofacial surgeon, together with other medical and dental specialists, can offer you the best chance of an accurate diagnosis and effective treatment.
What are the Symptoms of Obstructive Sleep Apnea?
• Snoring with pauses in breathing (apnea)
• Excessive daytime drowsiness
• Gasping or choking during sleep
• Restless sleep
• Problem with mental function
• Poor judgment/can’t focus
• Memory loss
• High blood pressure
• Nighttime chest pain
• Problem with excess weight
• Large neck (>17″ around in men, >16″ around in women)
• Morning headaches
• Reduced sexual drive
• Frequent urination urges at night
What are the Consequences of Untreated Sleep Apnea?
Depending on the severity of the diagnosis, you may experience some or all of these consequences if you do not treat your condition:
• High blood pressure (hypertension), which raises the risk of heart failure and stroke
• Heart Attack
• Irregular heartbeat
• Reduced sexual drive
How is Sleep Apnea Diagnosed?
If warranted, you family physician or one of or oral surgeons will also arrange for a sleep study to be performed. This sleep study will help to confirm a diagnosis of OSA, as well as evaluate the severity of the disease process. This sleep study (known as polysomnography) will be performed at a sleep lab where you will be monitored to determine disturbances in your sleep and the oxygen levels in your blood. Sometimes a breathing machine trial (CPAP) may be incorporated to evaluate its effects on your OSA.
If you or a family member exhibit symptoms of sleep apnea, you should visit Oral Surgery & Implant Specialists. One of our doctors will perform a thorough medical history and interview family members concerning your sleep habits.
In addition to a comprehensive physical exam, we may obtain a 3-Dimensional CBCT scan to evaluate your airway. Often, a sleep apnea team member may directly visualize your airway with a flexible fiber optic device (flexible nasopharyngoscopy.) This can be done comfortably in the office setting to further visualize possible sites of obstruction along your airway. Once the sites of obstruction are identified, appropriate treatment can begin.
Treatment for Sleep Apnea
Sleep apnea diagnosis and treatment is often done by a team. This team can include your family physician, family dentist, oral and maxillofacial surgeon, sleep medicine specialist, and an ear/nose/throat (ENT) specialist. This treatment team can offer the greatest expertise in care for obstructive sleep apnea.
OSA therapy may include surgical and non-surgical treatment. Non-surgical methods may include:
CPAP (Continuous Positive Airway Pressure)
In moderate to severe cases of Sleep Apnea, your treatment may involve wearing a CPAP device (see Figure 1) while you sleep. The CPAP mask provides pressurized air to limit airway obstruction for the sleeper.
It is important to understand that while CPAP may prove effective in treating sleep apnea, it is not a cure. If you stop using your CPAP device your symptoms will return, as will your risk of other diseases. CPAP has proven to be very effective in treating OSA, but patients often find it hard to tolerate long term. Studies show that compliance with CPAP after a period of 5 years can be as low as 20% .
Dental appliances, oral devices, and lower jaw adjustment devices
Dental appliances are typically effective for mild to moderate sleep apnea. Most devices are designed like mouth guards to fit inside your mouth, while others adjust the position of your lower jaw and open your airway by fitting around your head and chin.
Once again, it is important to remember that while dental and oral appliances may treat your OSA, they do not provide a cure. Symptoms and risks of others diseases return if you stop using your appliance.
Positional changes during sleep
Episodes of apnea often are greatest when sleeping on your back. Sometimes treatment as simple as learning to sleep on your side will significantly decrease the frequency and severity of sleep apnea.
In many cases, obesity can cause fat deposits along the airway and contribute to obstruction of the airway during sleep. Your OSA management team will recommend weight reduction goals if excess weight is thought to be a problem. If your weight is a serious problem, weight reduction surgery may be considered.
At Oral Surgery & Implant Specialists, we will work closely with the sleep apnea team in order to tailor a surgical procedure or procedures that will best address your individual needs. There are a number of procedures to treat OSA. These procedures address different areas of the upper airway. We often work closely and in conjunction with otolaryngologists and sleep specialists to obtain the best possible result for you.
Maxillomandibular Advancement (MMA)
MMA involves repositioning the upper jaw, lower jaw, and chin forward opening the airway posteriorly. This forward positioning helps to move the tongue forward while increasing the size of the posterior airway. This procedure is often performed in conjunction with correction any nasal airway problems, such as septal deviation or enlarged nasal turbinates. In contrast to the other temporary measures to assist you with your sleep apnea, surgical repositioning offers you the best chance of a permanent cure to your OSA, especially in moderate to severe cases. Studies have shown success rates with this surgery are better than 90%.
Tongue muscle advancement and palatal surgery
Sometimes, a more limited surgical approach can be performed. The bony attachment of the tongue muscles can be moved forward, and is often combined with reduction of excess palatal tissues, removal of enlarged tonsils, and nasal surgery. While not as predictable as MMA for the treatment of sleep apnea, this more limited surgical approach may be more appropriate in cases of moderate sleep apnea.
Our doctors will work closely with other members of your treatment team to give you the best possible diagnostic and treatment techniques available.