Obstructive Sleep Apnea
People with obstructive sleep apnea (OSA) have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the tongue and palate are sucked against the back of the throat. This blocks the 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. 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 airway consists of the nose and nasopharynx (passageway from the nose to the back of the throat), the mouth and oropharynx (back of the throat), the pharynx (behind the tongue leading to the glottis (the opening to the larynx (voice box)) the larynx and down into the trachea. Because the larynx (voice box) and trachea are stiffened by cartilage they usually hold their shape. The pharynx, nasopharynx and oropharynx however have soft tissue “walls” which are movable. The nose and nasal passages although stiff are tight and can add airway resistance.
OSA is analogous to the old paper straws (if you remember them). Initially they were stiff and you could suck through them with no problem. As they became wet they would soften and cave in and no longer could you suck fluid through them. The airway is similar. As you relax at night your tongue base falls back and the airway becomes obstructed.
Many factors contribute to this. In fact, your airway is like a set of resistors set in series. The nose is one source of resistance, the soft palate another, the tongue another. Resistance in one area causes a need for greater suction which in turn has more potential to cave in the airway and cause obstruction. All the areas should be addressed when diagnosing and treating OSA.
The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation. Our practice offers consultation and treatment options.
In addition to a detailed history, the Dr. Reynolds will assess the anatomic relationships in the maxillofacial region. With cephalometic (skull x-ray) analysis, he 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 individuals overnight. These are done at sleep center facilities.
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 sometimes done with the assistance of a laser and is called a Laser Assisted uvulo-palato-plasty (LAUP), but results with it have been poor. In other cases, a radio-frequency probe is utilized to tighten the soft palate. These procedures can sometimes be performed under light intravenous sedation in the office. Septoplasty and Turbinoplasty may be done to relieve resistance in the nasal passages.
In some cases, the bones of the upper and lower jaw may be repositioned to increase the size of the airway (follow this link to learn about Orthognathic Surgery). This procedure is done in the hospital under general anesthesia and may require 1 to 2 days overnight stay in the hospital. In many cases skeletal relationships are the primary problem and palatal surgery can be avoided because moving the upper jaw forward pulls the palate up and forward. Unfortunately many patients have palatoplasty before having a complete evaluation including cephalometrics. The advantage of repositioning the jaws is that several areas of obstruction can be addressed. By moving the lower jaw forward the tongue is advanced and the hyoid is naturally suspended. By moving the upper jaw forward the palate is advanced and shortened. By adding septoplasty, turbinoplasty and maxillary widening the nasal airway is improved.
OSA is a very serious condition that needs careful attention and treatment. Most major medical plans offer coverage for diagnosis and treatment.