Obstructive Sleep Apnea

Obstructive Sleep Apnea is a sleep disorder in which the patients airway is obstructed causing the patient to stop breathing several times per night. This disorder is typically identified by symptoms of loud snoring, excessive daytime sleepiness, pauses in breathing during sleep, morning headaches and sleepiness while driving. Obstructive sleep apnea, when untreated, can lead to other medical complications including high blood pressure, increased incidence of stroke and heart disease.

Since some forms of sleep apnea can lead to more serious conditions, early detection and treatment are important. There are many forms of conservative and surgical options available in the treatment of sleep apnea. Typically, treatment begins with a polysomogram (or sleep study) performed by a sleep disorders laboratory. This sleep study, along with clinical and radiographic examination, will provide our doctors with the necessary information to properly treat your sleep disturbance.

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 air flow 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.

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(s). Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera.

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. One of the surgical options is a uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. A similar procedure is sometime 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 are procedure usually performed under light intravenous sedation in the office.

In more complex cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (Orthognathic surgery). This procedure is done in the hospital under general anesthesia and requires 1 to 2 days 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.

Rate How Sleepy You Are:

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

SITUATION

Sitting and reading

Watching TV

Sitting, inactive in a public place (e.g. a theater or a meeting)

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

Sitting quietly after a lunch without alcohol

In a car, while stopped for a few minutes in traffic

CHANCE OF DOZING

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Scoring: Total all responses given. If your total number is greater than 10, you may suffer from a sleep disorder and should consult your family physician or specialist.

Treatment

There are various options that our doctors can utilize in the treatment of obstructive sleep apnea. Once an evaluation confirms a diagnosis of obstructive sleep apnea, our doctors will determine the proper course of treatment for you. Certain surgical procedures exist which may be deemed appropriate in certain instances. Sleep apnea is a comprehensive disorder sometimes requiring a team approach consisting of many specialists including oral and maxillofacial surgeons, ear, nose and throat specialists, pulmonologists, neurologists and primary care physicians.