Uncomplicated snoring is generally not considered a major concern; however, habitual snoring accompanied by symptoms such as daytime tiredness, apnea, high blood pressure, and depression may be a sign of severe sleep apnea.
Learn More About Sleep Apnea
Sleep apnea can occur as a result of obstruction or effort to breathe, and it occurs more frequently in those suffering from obesity, asthma, and congestive heart failure. Although sleep apnea can affect individuals at any age, it becomes increasingly common as the patient ages, which may be related to changes in airway anatomy, decreased muscle tone, or disorders associated with aging.
In these cases, it is important to seek care from an oral and maxillofacial surgeon familiar with the treatment of this condition. The surgeon can provide an important role in the evaluation and treatment of an individual with suspected sleep apnea.
The first step in diagnosing sleep apnea is usually obtaining a thorough history, including a review of the symptoms, as well as a physical examination. In addition to performing a visual examination to assess the degree of obstruction, the physician will also palpate – or feel –the neck and surrounding tissues for soft tissue abnormalities present in patients with obstructive sleep apnea.
As part of the examination, the patient may be asked to undergo a computerized tomography (CT) scan or magnetic resonance imaging (MRI) in order to assist in determining where the obstruction is occurring during sleep. The oral and maxillofacial surgeon will also take an X-ray to determine whether or not the individual has significant jaw abnormalities that would prevent them from wearing a typical CPAP mask.The next step is usually a sleep study called a polysomnogram or an overnight oximetry test. During this procedure, a variety of sensors are applied to the patient’s head and body to screen for other conditions that can contribute to obstructive sleep apnea, including heart disease, stroke, diabetes, and hypothyroidism. A polysomnogram will record the electrical activity in the brain during sleep; breathing patterns throughout the night; oxygen levels in the body; heart rate and rhythm during sleep. It will also identify periods of low blood pressure or decreased breathing.
Once it is determined that sleep apnea is present, the patient will be referred to a sleep specialist for treatment. The oral and maxillofacial surgeon can provide critical information about the individual’s breathing patterns, sleep disturbances, and overall health to the patient’s physician. They may also recommend surgical treatment to correct these conditions before the initiation of CPAP therapy. However, the first line of treatment for OSA patients is CPAP.
50% of patients are not able to tolerate CPAP in the long term. Many patients initially experience trouble wearing the mask at night because it is uncomfortable, or they develop sores on their face from infection or irritation; these issues can be alleviated by consulting with an oral and maxillofacial surgeon familiar with the treatment options of sleep apnea.
UPPP and LAUPP: During a uvulopalatopharyngoplasty (UPPP) surgery, the doctor will form an incision in the back of the soft palate and throat to remove excess soft tissue and then close the incision with sutures or staples. A laser-assisted uvulopalatoplasty (LAUPP) is a similar procedure done with the use of a laser. In some cases, a radio-frequency probe is used to tighten the soft palate. All these procedures are typically performed under light IV sedation in the office.
In the phased approach, UPPP and possibly adjunctive procedures, such as genioglossal advancement and/or hyoid repositioning/myotomy are performed as the initial phase of therapy. However, if all of these interventions do not have a successful outcome for the patient, major reconstructive jaw surgery may become unavoidable. Maxillomandibular advancement surgery, also known as corrective jaw surgery, is done to reposition the upper and lower jaw and release the ‘choke points’ that obstruct the airways. The improvements in sleep quality and decrease in cardiovascular risks appear similar to that of patients who regularly use a CPAP machine. This is a major surgery requiring about 6 hours and the recovery is 4-6 weeks long.