Obstructive sleep apnea (OSA) is a very common problem and as the name suggests, this condition greatly disrupts the normal breathing pattern while asleep and causes 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 from OSA can lead to very serious cardiovascular problems such as:
- High blood pressure
- Heart disease
Additionally, these individuals suffer from:
- excessive daytime sleepiness
- loss of concentration
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. Initial treatment may consist of Continuous Positive Airway Pressure (CPAP). CPAP delivers pressurized oxygen through a nasal mask to limit obstruction at night. One drawback of CPAP is many patients are unable to sleep well due to the bulky face mask and the noise of the machine. For those unable to tolerate CPAP surgical options are available:
- Uvulo-palato-pharyngo-plasty (UPPP), which is performed in the back of the soft palate and throat. This procedure corrects the laxity of the soft palate and may not address the actual area of obstruction (which is frequently the tongue). Success rates range from 41% to 65%.
- Uvulo-palato-plasty (LAUPP) is a similar procedure to UPPP and is sometimes done with the assistance of a laser and is called a laser assisted.
- 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.
- Maxillo-Mandibular Advancement (Orthognatic Surgery) is a much more predictable and successful surgical procedure. By advancing the jaws, the areas of obstruction are pulled forward thereby greatly opening the airway. Success rates for this procedure approach 90%. Therefore achieving important health benefits and requiring no further intervention.
Adjunct procedures are also available:
- Tongue base surgery
- Advancement of the chin (thus advancing the tongue)
For further information about this procedure please visit the “Jaw Surgery” tab on our website.
Dr. Dietrich is also part of the Mercy Medical Center Sleep Center Team.