Sleep Apnea

Screenshot_1People with obstructive sleep apnea (OSA) have disrupted sleep patterns and periods of low blood oxygen levels. When obstructive sleep apnea occurs, the tongue becomes stuck 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. This disruptive cycle may recur multiple times during a night of sleep.

Repeated cycles of decreased oxygenation may lead to very serious cardiovascular problems. Additionally, these people suffer from excessive daytime sleepiness, loss of concentration, and depression.

Some patients develop obstructions that are less severe called Upper Airway Resistance Syndrome (UARS). In either case, these individuals suffer many of the same symptoms.

The first step in treatment involves recognition of the symptoms and seeking appropriate consultation. Oral and maxillofacial surgeons can offer consultation and treatment options. There are also special sleep apnea clinics and teams to help diagnose and treat patients with OSA and other sleep disorders.

In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, 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 will be recommended to monitor an individual overnight.

There are several treatment options available. Initial treatment may consist of using a nasal CPAP machine that delivers pressurized oxygen through a nasal mask to limit obstruction at night. One surgical option is an uvulo-palato-pharyngoplasty (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-palatoplasty (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.

In more complex cases, the bones of the upper and lower jaw may be repositioned (orthognathic surgery) to increase the size of the upper airway.

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