People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue collapses thus creating heavy snoring and the inability to breath. 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.
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In addition to a detailed history, Dr. Krueger, Dr. Lenox and Dr. Welch will assess the anatomic relationships in the maxillofacial region. With 3D imaging analysis, Dr. Krueger, Dr. Lenox and Dr. Welch can ascertain the level of obstruction. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight.
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. For patients with mild to moderate OSA an oral appliance can be utilized. An appliance positions the lower jaw forward to open the airway for easy breathing.
One of the surgical options is a genioglossus advancement. This is where the chin region is brought forward, repositioning the tongue muscle in thus opening the airway.
In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. This procedure has proven to be a very predictable way to help eliminate sleep apnea for patients.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.
A uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat can help with some sleep apnea.
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