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Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a complex disorder that results in abnormal breathing patterns during sleep. Apnea is the lack of airflow through the mouth or nose and into the lungs for periods greater than ten seconds. In severe cases of OSA breathing stops completely for periods of time ranging from a few seconds to nearly one minute or longer. This may occur as many as 500 times during a 7 hour sleeping period. OSA is also associated with heavy snoring and significant disruption of normal sleep pattern. When breathing stops the normal oxygen supply to the body is greatly decreased and can result in a variety of serious medical problems including severe cardiac and respiratory problems. The disruption of normal breathing also causes frequent awakening that results in sleep deprivation which can lead to fatigue, daytime drowsiness, and depression. OSA is often associated with other health issues including high blood pressure and obesity. Most patients severely affected by sleep apnea are over the age of forty, but sleep apnea may occur at any age.

Figure 1

The cause of sleep apnea is from obstruction of airflow from the mouth or nose to the lungs. There are three potential levels of obstruction. Level one is within the nose or nasal cavity, level two is the soft palate or base of tongue and level three is hypopharynx or the portion of the throat just above the vocal cords (See Figure 1). The location of the area of obstruction determines the treatment that is most likely to eliminate or improve OSA. Many times these deformities can be compounded by neurologic disorders or obesity.

If one suspects OSA then an appointment should be made with your primary care physician for consultation and a complete physical examination. A consult with an oral and maxillofacial surgeon will include an examination of the mouth nose and throat and an x-ray of the skull and jaws. The final evaluation includes polysomnography or a "sleep study” which is completed at a sleep laboratory. Multiple monitors are placed while you sleep and numbers are assigned to determine one's severity of obstructive sleep apnea. After these evaluations an exact diagnosis can be confirmed and the appropriate treatment recommended.

Figure 2

Moderate or severe sleep apnea usually requires some form of treatment and different modalities are available. Conservative treatments can include medical management, weight loss, oral appliances, and or positive pressure masks or CPAP machines. CPAP involves wearing a mask connected to a machine that pushes air under pressure into the collapsed airway to improve breathing. This requires wearing this apparatus during sleep. Many patients can not tolerate use of the mask and results are inconsistent. Surgical treatment may be indicated and may involve surgery of the soft palate and throat. In many cases surgery to improve the position of the jaw bones results in improved support of the soft tissue and a significant opening of the airway (Figure 2). Upper and lower jaw advancement combined with intranasal surgery can often relieve the obstruction at all levels and may greatly improve moderate to severe obstructive sleep apnea.

Jaw surgery is not for all who have obstructive sleep apnea and a complete medical history and physical exam by one of our trained surgeons will determine treatment options and the risk and benefits of each. Please contact one of our offices for more information.


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