Procedures
Sleep Apnea
What is 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.
First Step Toward Treatment
The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. In many cases a sleep study will be the first step in the treatment process. Dr. Krueger works very closely to the sleep lab at St. Charles medical center to determine if a patient is suffering from sleep apnea. The sleep study provides Dr. Krueger with information regarding the amount of cardiovascular compromise and decreased oxygenation levels. In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis and/or 3 Dimensional CT Scan the doctors can ascertain the level of obstruction.
Treatment Options for Sleep Apnea
There are several treatment options available. An initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. Another option similar to the CPAP is a splint. The splint is used at night and holds the lower jaw forward to limit the obstruction during sleeping hours. Sometimes slight stiffness of the jaw is apparent in the morning after using a splint but resolves usually in about 15 to 20 minutes.
Surgical Treatment Options
In more complex cases, surgical procedures may need to be utilized to increase the size of the airway. These procedures are done in the hospital under general anesthesia and require 1 to 2 days overnight stay in the hospital.
Uvulo-Palato-Pharyngo-Plasty (UPPP): This procedure would be done by and Ear, Nose, and Throat Surgeon. This procedure involves reducing the tissue of the soft palate and/or throat, thus creating a larger airway.
Genioglossus advancement: This procedure would involve moving the muscles attaching to the tongue forward, thus moving the posterior portion of the tongue forward was well. This would limit the amount of obstruction while you are sleeping.
Mandibular advancement: For this procedure Dr. Krueger would need to advance the mandibular (lower jaw) by separating the back portion of it and sliding it forward. This too would limit the amount of obstruction while you are sleeping.
LeFort: This procedure involves moving both the upper and lower jaw forward to increase airway space.
Dr. Krueger performs all surgeries at St. Charles Medical Center in Bend, OR. Prior to the surgery you will have several office visits regarding additional options, a history and physical, and will be shown videos of how the procedure will be completed.
