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.

Sleep Apnea Treatment

The first step in treatment for sleep apnea 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 Cone Beam CT and cephalometic (skull x-ray) analysis, the doctors can ascertain the level of obstruction. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera. To confirm the amount of cardiovascular compromise and decreased oxygenation levels, a sleep study may be recommended to monitor an individual overnight. These can be done either at a sleep center or at home with specialized devices that record your sleep patterns and apneic episodes. 

Treatment Options for Sleep Apnea

There are several treatment options available for OSA. Our surgeons are experts diagnosing this condition and determining the best treatment options for you.

Initial treatments may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night.

Another non invasive options include mandibular repositioning devices that allow your lower jaw and the associated soft tissues including the tongue to be positioned more anteriorly. This allows your airway to be wider which in turns decreases your apnea episodes at night. These devices require intra oral scans and careful planning and coordination with a specialized apnea dental lab. Our maxillofacial surgeons are also both physician and dentists and they are experts in diagnosing and ordering these devices after a thorough consultation.

One of the surgical options is an uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometimes done with the assistance of a laser and is called a laser assisted uvulo-palato-plasty (LAUPP). In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures are usually performed under light IV sedation in the office.

The bones of the upper and lower jaw are sometimes not properly aligned and may need to be repositioned to increase the size of the airway (orthognathic surgery). This procedure is done either in our accredited surgical center or in the hospital under general anesthesia and sometimes requires a one to two day overnight stay in the hospital. A complete facial and skeletal analysis is performed to determine if you are a candidate for this procedure.

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

See below an examples Facial and Oral Surgery Specialists patients with OSA who benefited from orthognathic surgery to improve their airway dimension. This improved not only their appearance and function but also quality of life, memory, energy and overall health.


 Patient 1

sleep apneaBefore Orthognathic Surgery
Severe OSA
Total Airway  Volume 18.6cc
Severe constriction at level of oropharynx
sleep apneaAfter Orthognathic Surgery
Normal Airway Values
Total Airway Volume 30.7cc, 2 weeks post-surgery 
Improvements in Nasopharynx, Oropharynx and Hypopharynx Dimensions
Improved breathing


Airway:

Corrective Jaw Surgery or Jaw Repositioning Surgery can have drastic benefits for the airway. In addition to producing dramatic changes to the person’s appearance and overall function, the airway changes are immediate. In this video, two scans taken about 2 weeks apart show that the Posterior Airway Space (PAS) has more then doubled ! The patient still has some post-operative swelling therefore the PAS is expected to improve even more.

Some Benefits of Treating OSA :

Decreased Sleepiness (more energy)
Improved Quality of Life
Decreased cardiovascular risk (better heart function)
Improved neurocognitive performance (better brain function)

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