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.
The first step in treatment 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 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.
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.
Oral Appliance Therapy
Oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea (OSA), mainly mild to moderate cases. A custom-fit oral sleep appliance can improve your sleep, restore your alertness and revitalize your health. Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the lower jaw in a forward position to help maintain an open upper airway. Research shows that oral appliance therapy is an effective treatment option for snoring and obstructive sleep apnea.
Sleep apnea oral appliances work by moving the lower jaw, or mandible, forward relative to the upper jaw, maxilla. This increases the air passage way reducing, and often eliminating, snoring and sleep apnea.
The sleep apnea oral appliances are adjustable in small increments in order to provide comfort and increase airway. Oral appliance therapy is an effective, non-invasive treatment that fits easily into your lifestyle. Patients like oral appliance therapy because it is:
Easy to wear
Convenient for travel
Easy to care for
Making and Fitting Your Oral Appliance:
Oral appliances are customized using impressions and models of your teeth. These models are sent to a dental lab where the appliance is made. Once your oral appliance is ready, you will return to your surgeon’s office for a fitting. Your surgeon will adjust the appliance to maximize its comfort and effectiveness. You also will learn how to clean the oral appliance and maintain it. You may need a follow up sleep study to verify treatment success.
Follow-up visits will be needed to ensure the optimal fit of the oral appliance. Effective oral appliances are always custom fit and adjusted over time to ensure maximum effectiveness.
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.
Hyoid Suspension: The hyoid bone is located above the level of the thyroid cartilage (Adam’s apple). The procedure secures the hyoid bone to the thyroid cartilage to help stabilize this region of the airway.
Genioglossus Advancement (GGA): This procedure tightens the front tongue tendon, reducing the degree of tongue displacement into the throat. This operation is often performed in tandem with at least one other procedure such as UPPP or hyoid suspension.
Maxillomandibular Advancement (MMA)
This procedure surgically moves the upper and lower jaws forward along with the soft tissues of the tongue and palate, opening the upper airway. For some patients, the MMA is the only technique that can create the necessary air passageway. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.