When obstructive sleep apnea (OSA) 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 or snore. Not all patients who snore will have OSA and as well, not all patients with OSA will snore. Assessment by a sleep center is essential in the proper management of the problem.
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.
If you answer Yes to 3 or more of these questions, there is a high likelihood of OSA:
- Do you snore loudly enough to be heard through a closed door?
- Do you feel tired during the daytime, feel unrefreshed following sleep or ‘doze off’?
- Has your bed partner witnessed episodes of long periods of not breathing/
- Are you being treated for high blood pressure/
- Is your Body Mass Index (weight in kilograms divided by height in meters squared, BMI) greater than 35?
- Are you male and over 50 years old?
- Is you neck size greater than 17″ or 40cm?
In addition to a detailed history, the doctors will assess the anatomic relationships in the maxillofacial region. With cephalometric (skull x-ray) analysis, the doctors can ascertain the level of obstruction. In most cases, an over night sleep study will be ordered.
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 appliances that allow the lower jaw to be advanced during sleep have been devloped and are often indicated in mild and moderate OSA. The “Klearway appliance” was developed by Dr. Alan Lowe of the Department of Orthodontics at the University of British Columbia, and is often suggested as an option by Drs. McCann or Ledderhof.
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 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.